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61st Congress \ SENATE I Document 

2d Session ] \ No. 419 



NATIONAL VITALITY 

ITS WASTES AND CONSERVATION 

IRVING FISHER 



Extract from Report of the National Conserv^Tion Commission 

(Senate Document No. 676, Vol. Ill, Sixtieth 

Congress, second session) 






PRESENTED BY MR. OWEN* 



.March 8, 1910. — Ordered to he printed, with illustration 

WASHINGTON 
GOVERNMENT PRINTING OFFICE 

1910 



«,* 



i 



Y« 



NATIONAL VITALITY, ITS WASTES AND CONSERVATION. 



By Irving Fisher, 
Professor of Political Economy, Yale University. 



ACKNOWLEDGMENTS. 

The materials upon which this report is principally based were 
collected during the last ten years. They are far from complete, and 
I had expected to make use of them at my leisure for a series of 
special articles, but the opportunity which suddenly presented itself 
of utilizing them in 0e construction of this report was one which 
could not be resisted, despite the fact that the time available was 
only three months. In the endeavor to make the best use of this 
time I have been compelled in some cases to rely on secondary 
sources of information. The number of such cases has been greatly 
reduced, however, through the kindness of colleagues, friends, and 
correspondents who were appealed to for suggestions, criticisms, and 
supplementary material. I am greatly indebted to Prof. Lafayette 
B. Mendel, of the Sheffield Scientific School of Yale University, for 
helpful comments and detailed criticism of the whole report, and 
especially of those parts relative to the physiology of nutrition; to 
Prof. Yandell Henderson, for many helpful suggestions; to Prof. 
Henry W. Farnam, for suggestions regarding the topics of industrial 
conditions; to Prof. M. V. O'Shea, of the University of Wisconsin, 
for carefully revising the major part of the section on school hygiene ; 
to Dr. Charles Wardell Stiles, Chief of the Division of Zoology, 
Hygienic Laboratory, United States Public Health and Marine- 
Hospital Service, for information on the extent and burden of the 
hook-worm disease ; to Surg. Gen. Robert M. O'Reilly, of the United 
States Army, for statistics of army hygiene; to Dr. Prince A. Mor- 
row, of New York City, and to Prof. C. R. Henderson, of the Uni- 
versity of Chicago, for carefully prepared notes in regard to " the 
social evil." 

I am indebted to Dr. Herbert E. Smith, dean of the Yale Medical 
School, for general criticism ; and to his colleagues, Profs. Joseph M. 
Flint, George Blumer, H. L. Swain, and Oliver T. Osborne, for 
criticism and aid, both general and special. 

Among the many others who have rendered very valuable assist- 
ance I would especially mention Dr. J. H. Townsend, secretary Con- 
necticut state board of health; Dr. Cressy L. Wilbur, Chief of 
Division of Vital Statistics, Bureau of the Census; Col. W. C. 
Gorgas, chief sanitary officer, Isthmian Canal Commission ; Dr. J. N. 
Hurty, secretary of the state board of health of Indiana ; Dr. Charles 
V. Chapin, city health officer, Providence, R. I. ; Dr. George H. Sim- 
mons, of Chicago, secretary of the American Medical Association; 
Dr. J. N. McCormack, lecturer of the American Medical Association ; 
Dr. William J. Mayo, formerly president of the American Medical 
Association; Dr. Henry P. Walcott, president Massachusetts state 
620 

K?R 9 1910 



fisher.] NATIONAL VITALITY. 621 

board of health ; Prof. F. F. Wesbrook, dean of the Medical School 
of the University of Minnesota; Dr. Henry B. Baker, ex-secretary 
Michigan state board of health; Dr. William C Woodward, health 
officer of the District of Columbia; Dr. George M. Kober, dean of 
Georgetown Medical College; Dr. Norman E. Ditman, of Columbia 
University; Dr. J. H. Kellogg, superintendent of the Battle Creek 
Sanitarium, and his assistants, Dr. J. T. Case and Dr. W. H. Riley; 
Dr. Richard C. Newton, of Montclair, N. J. ; Dr. Luther H. Gulick, 
of New York City; Dr. W. G. Anderson, director Yale gymnasium; 
Dr. Charles H. Castle, of Cincinnati, Ohio; Dr. J. P. C. Foster, of 
New Haven; Prof. Russell H. Chittenden, director of the Sheffield 
Scientific Schoolof Yale University; Leo F. Rettger, assistant pro- 
fessor of hygiene, Yale University ; Dr. George M. Gould, of Ithaca, 
N. Y. ; Dr. Helen C. Putnam, of Providence, R. I.; F. B. Sanborn, 
of Cambridge, Mass. ; Hiram J. Messenger, actuary of the Travelers 
Insurance Company, Hartford; Mrs. Ellen H. Richards, of the 
Massachusetts Institute of Technology; Mrs. Frank P. Kinnicutt, of 
New York City ; and William H. Tolman, of the Museum of Safety 
and Sanitation, New York City. 

To the help received from these persons will be due in large measure 
whatever of value this report may have. I could not, single-handed, 
have done justice to even a portion of the subject. Except for a few 
statistical monographs and papers cited in it, I have contributed 
little original material. It has been my task to interpret material 
brought together from many sources. Despite all the aid received, I 
am aware that the report abounds in sins of omission. Great pains 
have been taken to avoid those of commission. Doubtful material 
has been eliminated so far as possible, and where exact figures were 
unobtainable, every effort has been made to see that the statements 
made should be cautious and conservative. 

For aid in the difficult work of incorporating into the manuscript 
the numerous suggestions received, I am indebted to Profs. J. Pease 
Norton, WillianTB. Bailey, Fred R. Fairchild, and Dr. L. W. Zart- 
man, of the economic department of Yale University; and to Dr. 
M. M. Scarborough, of the Yale Medical School, and Dr. F. B. 
Standish, of New Haven. For criticisms on the form of presenta- 
tion, I am indebted to Mr. Edwin Bjorkman, of New York City; 
to Mr. Michael Williams, of Oak Bluffs, Mass. ; and to Mr. Herbert 
A. Smith, of the U. S. Forest Service. 

I wish to thank the Interstate Commerce Commission and Prof. 
Henry C. Adams, the statistician of the commission, for temporarily 
detailing Mr. Julius H. Parmelee, a member of the Statistical Division 
of the Interstate Commerce Commission, to the work of compiling the 
material gathered from various sources. Mr. Parmelee has brought to 
his work an unusual equipment. His studies have been not only in 
statistics, but also in hygiene. Added to his knowledge he has en- 
thusiasm for the subjects covered and a keen appreciation of their 
importance. The aid which he has rendered has been much more 
than that of mere calculator and compiler. His ability, thought-ful- 
ness, and self-sacrificing devotion have resulted in painstaking work 
of a high order, without which the report could not have been written 
in the allotted time. 

Irving Fisher. 

Yale University, November, 1908. 



SUGGESTIONS FOR READERS. 

In order that this report may be read and used as widely as pos- 
sible, it has been arranged with reference to five classes of readers : 

1. The " Contents by sections," the index, and the page headings 
will facilitate the use of the report for reference purposes. 

2. The " Abstract " is chiefly intended for those who have no time 
to read more. 

3. The " Summary " is a somewhat fuller resume. 

4. The " Summary " is also designed to enable those who so desire 
to read some parts of the report more fully than others. To this end 
the " Summary " is arranged to correspond to the main report, chap- 
ter by chapter and section by section. The reader who, after reading 
any particular part of the " Summary," wishes to read the corre- 
sponding part of the main report has only to turn to the chapter or 
section having the same number. 

5. Those who read the entire report will probably prefer to read 
the "Summary" or "Abstract" last. 

622 



ABSTRACT. 

The problem of conserving natural resources is only one part of the larger 
problem of conserving national efficiency. The other part relates to the vitality 
of our population. The two parts are closely interwoven. Protection against 
mining accidents, forest fires, floods, or pollution of streams prevents not only 
loss of property, but loss of life. The prevention of disease, on the other hand, 
increases economic productivity. 

So far as we can compare vital and physical assets as measured by earning 
power, the vital assets are three to five times the physical. The facts show 
that there is as great room for improvement in our vital resources as in our 
lands, waters, minerals, and forests. This improvement is possible in respect 
both to the length of life and to freedom from disease during life. 

Contrary to common impression, there is no iron law of mortality. Recent 
statistics for India show that the average duration of life there is less than 
twenty-five years. In Sweden it is over fifty years, in Massachusetts forty-five 
years. The length of life is increasing wherever sanitary science and prevent- 
ive medicine are applied. In India it is stationary. In Europe it has doubled 
in three and a half centuries. The rate of increase during the seventeenth and 
eighteenth centuries was about four years per century, during the first half of 
the nineteenth century about nine years per century, during the latter half of 
the nineteenth century about seventeen years per century, and in Germany, 
where medical and sanitary science has reached the highest development, about 
twenty-seven years per century. The only comparative statistics available in 
this country are for Massachusetts, where life is lengthening at the rate of 
about fourteen years per century, or half the rate in Germany. 

There is no need, however, of waiting a century for this increase. It could 
be obtained within a generation. Three-fourths of tuberculosis, from which 
150,000 Americans die annually, could be avoided. Eighteen experts in various 
diseases, as well as vital statisticians, have contributed data on the ratio of 
preventability of the ninety different causes of death into which mortality 
may be classified. From these data it is found that fifteen years at least could 
be at once added to the average human lifetime by applying the science of 
preventing disease. More than half of this additional life would come from the 
prevention of tuberculosis, typhoid, and five other diseases, the prevention of 
which could be accomplished by purer air, water, and milk. In Lawrence, 
Mass., after the installation of a pure-water supply, the death rate from typhoid 
was reduced by 80 per cent. For every death thus saved from typhoid, two 
or three deaths are saved from other diseases. 

Judging from the English statistics of illness, we must conclude that at all 
times in the United States about 3,000,000 persons are seriously ill, of whom 
about 500,000 are consumptives. Fully half of this illness is preventable. 

If we appraise each life lost at only $1,700 and each year's average earnings 
for adults at only $700, the economic gain to be obtained from preventing pre- 
ventable disease, measured in dollars, exceeds one and a half billions. This 
gain, or the lengthening and strengthening of life which it measures, can be 
secured through medical investigation and practice, school and factory hygiene, 
restriction of labor of women and children, the education of the public in both 
public and private hygiene, and through improving the efficiency of our munic- 
ipal, state, and national health service. Our National Government has now 
several bureaus exercising health functions, which only need to be concentrated 
under one department to become coordinated parts of a greater health service 
worthy of the nation. 

623 



SUMMARY. 
Summaey of Part I. — Length of life versus mortality. 

SUMMARY OF CHAPTER I — THE LENGTH OF LIFE. 

Section 1. In different places. — President Roosevelt has pointed out that the 
problem of conserving our natural resources is part of another and greater prob- 
lem — that of national efficiency. This depends not only on physical environment, 
but on social environment, and most of all on human vitality. Modern hygiene 
is the reaction against the old fatalistic creed that deaths inevitably occur at a 
constant rate. The new motto is that of Pasteur : " It is within the power of 
man to rid himself of every parasitic disease." 

It was once believed that human mortality followed an " inexorable law." 
Facts, however, show that mortality varies in different places and is decreasing 
as hygiene comes into use. The length of life in Sweden and Denmark is over 
fifty years ; in the United States and England about forty-five ; in India less than 
twenty-five. 

Sec. 2. At different times. — In Europe, according to one authority, the length 
of life has increased in three hundred and fifty years from less than twenty to 
about forty years ; in England, in less than half a century, it has increased about 
five years; in Prussia, in the last quarter of a century, over six years; in 
America it has also increased, although good life tables are lacking excepting 
for insurance experience. The tables for Massachusetts for 1893-1897 show an 
average duration of life in that State of forty-five years, as compared with forty 
in 1855, and thirty-five, an estimate of 1789, based, however, on doubtful returns. 

SUMMARY OF CHAPTER II — THE MORTALITY RATE. 

Section 1. — Relation of longevity to mortality. — As duration of life increases 
the death rate decreases. A death rate is the ratio of the number of deaths in 
a year to the population. Under normal conditions where the population is 
" stationary " — that is, neither increasing nor decreasing nor subject to immigra- 
tion or emigration — the death rate and the duration of life are " reciprocals." 
In such a population, if the death rate is 20 per 1,000, the duration of life will be 
1,000-^20=50 years. 

This relation, however, is disturbed in most countries to-day, and especially in 
America, by immigration and emigration and by the birth rate being in excess 
of the death rate. Nevertheless, death rates, if compared under similar condi- 
tions, furnish a fairly good index of vitality. They vary in different places and 
at different times. 

Sec. 2. Mortality in various regions. — In the registration area of the United 
States the death rate is 16.5 per 1,000 ; in France it is 20 ; in India 42. In dif- 
ferent States of the United States it varies from 14 in Michigan to 18 in New 
York. 

Sec. 3. Urban and rural mortality. — The death rate is higher in the city than 
in the country, and the larger the city the higher the death rate. In European 
countries among the cities with the highest death rate are Dublin (40) and 
Moscow (37) ; among the lowest, Frankfort on the Main (16) and The 
Hague (16). 

Sec. 4. Race and condition. — The colored death rate greatly exceeds the white. 
The death rate among the poor exceeds that among the rich, being in Glasgow 
and Paris over twice as great. 

Sec. 5. Mortality historically. — Death rates have been decreasing during sev- 
eral centuries. In London, where now the death rate is only 15, it was during 
the seventeenth and eighteenth centuries 40 to 50, and during 1680 to 1728, a 
period of pests, it rose as high as 80. Similar reduction has also been experi- 
enced in this country. In Habana the death rate after the American occupa- 
tion fell from over 50 to about 20. 

624 



fished] NATIONAL VITALITY. 625 

Sec. 6. Adult and infant mortality. — The greatest reduction has been effected 
among children, although the death rate is still undoubtedly high. Statistics 
show that during the last thirty years the death rate up to 50 years of age has 
decreased, but that beyond 50 it has remained almost stationary. 

Sec. 7. Particular diseases. — The mortality from certain special diseases has 
greatly decreased. The tuberculosis death rate is now in England only one- 
third of what it was seventy years ago. The death rate from pneumonia now 
equals that of tuberculosis. Typhoid fever is decreasing. In Munich during 
1856 the mortality was 291 per 100,000 of population. The city at that time 
contained many cesspools. After these were filled up the typhoid rate fell to 10 
per 100,000 in 1887, making a reduction of 97 per cent. In Lawrence, Mass., 
after the public water was filtered in 1893 the typhoid-fever rate fell from 105 
to 22. Doctor Kober has shown that death rates from typhoid fever are great- 
est in cities in which the rivers' waters are polluted, the average for these 
cities being 62, as compared with 18 for cities using unpolluted water of 
impounded and conserved streams. Doctor Rosenau concludes that any com- 
munity having clean water and uninfected milk supply may be free from 
typhoid. 

Smallpox has greatly decreased since vaccination has been employed. In 
Prussia the death rate per 100,000 from smallpox between 1846 and 1870 was 
24. In 1874 vaccination was made compulsory, and the death rate for the years 
1875-76 fell to 1.5. Similar figures can be given for other places. The present 
outcry against vaccination is based on misinformation and on the general rea- 
soning that it is unnatural to introduce a poison into the blood. Statistics show 
clearly that vaccination decreases smallpox and lengthens life. Even though it 
were shown that the virus is injurious, it would be the lesser of two evils. 

Yellow fever in Philadelphia in 1793 caused the death of one-tenth of the 
city's population within six and one-half weeks. In 1900 it was found that a 
species of mosquito transmits this disease. The result of this applied knowl- 
edge is that the disease has practically disappeared in America. 

Summary of Part II. — Breadth of life versus invalidity. 

SUMMARY OF CHAPTER III — PREVALENCE OF SERIOUS ILLNESS. 

Section 1. Loss of time. — Life is shortened by death and narrowed by inva- 
lidity. The ideal life, with respect to health, would be free from illness and dis- 
ability of every kind. To approximate such an ideal is the aim of hygiene. It 
is usually true that the healthier a life the longer it will last. Humboldt main- 
tained that he had lived four working lives by retaining a working power double 
the average for double the average number of years. According to Farr, for 
every death there is an average severe sickness of two years, or for each death 
per year there are two persons sick throughout the year. This would mean in 
the United States that, as there are about 1,500,000 annual deaths, there will 
always be about 3,000,000 persons on the sick list, which is equivalent to about 
thirteen days per capita. 

Sec. 2. Particular diseases. — There are constantly ill in the United States of 
tuberculosis about 500,000 persons, of whom about one-half are totally incapac- 
itated, while the remainder are half incapacitated. The causes of various 
diseases are closely interwoven. Professor Sedgwick tells us that " Hazen's 
theorem " shows for every death from typhoid fever avoided by the purification 
of a polluted water supply two or three deaths are avoided from other causes. 
Hook-worm disease in the South is a chief cause of incapacitation, especially 
among the poor whites. For this reason the hook worm has been nicknamed the 
" germ of laziness." It is believed tbat a sufferer from hook-worm disease is 
incapacitated from one-fourth to one-half of the time. 

The number of syphilitics in the United States has been estimated at 2,000,000, 
though from the nature of the case this figure is chiefly conjecture. The social 
diseases, syphilis and gonorrhea, are responsible for the existence of a large 
proportion of defectives of various kinds which fill our institutions. Among the 
troops in the Philippines the venereal morbidity, during the year 1904, was 297 
per 1,000, largely exceeding the morbidity from malarial fevers and diarrhea, as 
22 out of every 1,000 soldiers were constantly ineffective from venereal disease — 
four times as many as from any other disease. The statistics outside of army 
and navy service are impracticable, but there is some reason to believe that they 
might show an even larger morbidity. The social diseases, which certainly are 
preventable, are one of the gravest of the menaces to national efficiency. 



626 REPORT OP NATIONAL CONSERVATION COMMISSION". 

American railways in 1907-8 killed nearly 11,800 and injured nearly 111,000 
persons. The deaths and disablements from accidents in industry, although 
less carefully recorded, also represent a great and needless impairment of 
efficiency. 

SUMMARY OF CHAPTEE IV — PREVALENCE OF MINOR AILMENTS. 

Section 1. Importance of minor ailments. — Minor ailments are far more com- 
mon than most persons realize. They are chiefly functional disorders, such as of 
the stomach, heart, nerves, liver, kidney, etc. These deserve more attention 
than they have hitherto received, because they are the gateway to more serious 
troubles. For instance, those who neglect colds, or what seem to be colds, 
will be far more likely to become victims of tuberculosis or pneumonia. No 
statistics of the prevalence of minor ailments exist. Physicians, whose experi- 
ence gives them good opportunity to judge, place the time lost annually for each 
person from minor ailments at three or more days a year. 

Sec 2. Prevent ability of minor ailments.— Practically all minor ' ailments 
can be avoided by proper hygiene, public and private. Neurasthenia, so common 
in America, is one of the most serious and insidious introductions to grave 
disorders, and is usually due to needless worry or failure to have adequate 
recreation. 

SUMMARY OF CHAPTEE V — PREVALENCE OF UNDUE FATIGUE. 

Section 1. Strength, endurance, and fatigue. — Strength is measured by the 
force a muscle can exert once ; endurance by the number of times it can repeat 
an exertion requiring a specified part of the strength. Fatigue is a chemical 
effect, due to " fatigue poisons." Far greater differences exist between differ- 
ent persons in respect to endurance than in respect to strength. Some " well " 
people become tired by a short walk, while others withstand hours of walk- 
ing, running, or climbing. 

Sec 2. Alcohol and fatigue. — The " Committee of Fifty " found that alcohol 
gives no persistent increase of muscular power. It is well understood by all 
who control large bodies of men engaged in physical labor that alcohol and 
effective work are incompatible. Rivers, writing on the influence of alcohol on 
fatigue, found that when workmen were provided with a moderate amount of 
wine it resulted in a considerable diminution of their capacity for work. 

Sec 3. Tobacco and fatigue. — Athletes recognize that smoking interferes 
with one's " wind " or " staying power." " Inhaling " tobacco smoke brings 
carbon-monoxide directly into the blood stream. It is found that smoking in- 
creases blood pressure, which fact possibly partly explains the reduction in 
endurance. 

Sec 4. Diet and fatigue. — When excessive amounts of the protein element 
in food (exemplified in white of egg or the lean part of meat) are taken, they 
putrefy in the large intestine, producing " auto-intoxication." For this and 
other reasons, there is a present tendency among physiologists to advise a 
reduction in the use of such foods from the amounts customary in many coun- 
tries, and especially in the United States. Auto-intoxication induces fatigue. 
The endurance of those using high protein and of those using low protein shows 
in general, although with some exceptions, that the former have less endurance 
than the latter. Whether the latter are vegetarian or not does not seem to 
matter. Experiments show that thorough mastication leads instinctively to a 
reduction in protein. 

Sec 5. Exertion and fatigue. — Oxygen, whether taken naturally or artificially, 
increases the capacity for exertion. A judicious amount of exercise is per- 
haps the chief factor in producing the highest state of muscular efficiency. 
Physical training, comprising exercise and other hygienic measures, will prob- 
ably make the capacity to withstand great exertion three or four times that 
possessed by most persons. 

Sec 6. The working day. — The present working day, from a physiological 
standpoint, is too long, and keeps the majority of men and women in a con- 
tinual state of overfatigue,. It starts a vicious circle, leading to the craving 
of means for deadening fatigue, thus inducing drunkenness and other excesses. 
Experiments in reducing the working day show a great improvement in the 
physical efficiency of laborers, and in many cases results in even increasing 
their output sufficiently to compensate the employer for the shorter day. Several 



fisher.] NATIONAL VITALITY. 627 

examples of sueli a result exist, but the real justification for a shorter work day- 
is found in the interest of the race, not the employer. One company, which 
keeps its factory going night and day, found, on changing from two shifts of 
twelve hours each to three shifts of eight hours each, that the efficiency of the 
men gradually increased, and the days lost per man by illness fell from seven 
and one-half to five and one-half per year. Public safety requires, in order to 
avoid railway collisions and other accidents, the prevention of long hours, lack 
of sleep, and undue fatigue in workmen. 

Sec. 7. The importance of preventing undue fatigue. — The economic waste 
from undue fatigue is probably much greater than the waste from serious ill- 
ness. This is because the number of fatigued persons is great enough to more 
than outweigh the fact that the incapacitation from fatigue is relatively small. 
Moreover, the relatively slight impairment of efficiency due to overfatigue leads 
to greater impairment from serious illness. A typical succession of events is, 
first, fatigue, then " colds," then tuberculosis, then death. The prevention of 
undue fatigue means the arrest at the start of this accelerating chain of 
calamities. 

Summary of Paet III. — Methods of conserving life. 

SUMMARY OF CHAPTER VI — CONSERVATION THROUGH HEREDITY. 

Section 1. Heredity and environment. — A wise and farsighted economy will 
lead the nation to conserve its vital resources by every possible method. These 
resources depend on two primary conditions, heredity and hygiene, or conditions 
preceding birth and conditions during life. In other words, vitality is partly 
inherited and partly acquired. A sound physical and mental inheritance is a 
greater asset than the inheritance of extraneous advantages like wealth. Even 
in the Old World a degenerate nobility in the end receives less respect than a 
virile middle class. The effort to improve vitality reaches its highest point in a 
nation when its health ideals affect marriage. 

Sec 2. Eugenics. — Galton, Pearson, and others are attempting to found the 
new science of " eugenics," by which is not meant any scheme of general govern- 
mental interference with marriage, but the gradual establishment in public 
opinion of fundamental standards. Just as to-day the marriage of brother and 
sister is unthinkable, Galton suggests that the time may come when marriage 
which obviously promotes degeneration will be equally tabooed. The result 
would be, not to make marriage more artificial, but less. Health, beauty, and 
vitality are much more natural objects of youthful admiration than titles or 
wealth, which now exercise, for the most part, a baneful influence on marriage. 
To lessen the esteem for those false attractions and increase that for natural 
attractions will tend not only to increase the number of healthy marriages, but 
to give greater importance to natural and normal love. The effect will be felt 
both in bringing about a larger proportion of marriages among the healthy and 
a smaller proportion among the unhealthy. It will also lead to a partial segre- 
gation by which the healthy will to a large extent marry among themselves, and 
thus leave the unhealthy either unmarried or compelled to make alliances in 
their own class. The result will be, in the struggle for race supremacy, that 
the healthy, thus separated off from the relatively unfit, will have a distinct 
advantage both in the number of offspring and in their vitality. 

Sec 3. Eugenics and law. — The only government influences which have been 
seriously suggested by eugenists are two : First, the offering of prizes or 
bounties to couples who conform to certain standards, in the same way as the 
French Government has encouraged the increase of its population by offering 
inducements to couples of the poorer class who raise seven or more children ; 
second, to prevent marriage alliances among criminals, paupers, and the feeble- 
minded. Some laws on these subjects already exist in Connecticut, Michigan, 
and especially Indiana, where there is a prohibition of marriage of all persons 
suffering from transmissible diseases. It is also now provided in Indiana that 
confirmed criminals, imbeciles, and rapists, when it is deemed advisable by 
experts, shall be unsexed. What such laws might accomplish may be judged 
from the history of two criminal families, the " Jukes " and the " Tribe of 
Ishmael." Out of 1,200 descendants from the 'founder of the " Jukes " through 
seventy-five years, 310 were professional paupers, who spent in all two thousand 
three hundred years in poorhouses, 50 were prostitutes, 7 murderers, 60 habitual 
thieves, and 130 common criminals. The loss of potential usefulness, cost of 



628 REPORT OF NATIONAL CONSERVATION COMMISSION. 

prosecutions, expense of maintenance of jails, etc., Dugdale estimated to be 
$1,300,000 in seventy-five years, or over $1,000 for each member of the family. 
All these unfortunate results could have been avoided had the original criminals 
in this family been sterilized under a law like that of Indiana. 

We have the more agreeable record of excellent human qualities inherited 
through successive generations in the Darwin, Hohenzollern, and other families. 

SUMMARY OF CHAPTEE VII CONSERVATION THROUGH PUBLIC HYGIENE. 

Section 1. Municipal hygiene. — The benefits of improved heredity can be en- 
joyed only by future generations. But we of the present day may conserve our 
vital resources through hygiene, practiced in one or all of three ways — public, 
semipublic, and personal hygiene. The first refers to governmental regulation 
of health, the second to the professional or institutional care of health, and the 
third to the private life of the individual and the family. Every city now has 
its health board, yet few citizens realize that the protection rendered by these 
boards is more important than the protection by the police or fire departments. 
Much as is done by these boards, there is enormous room for improvement, both 
in making regulations and in enforcing them by the aid of a more enlightened 
public opinion. The abatements of the nuisance and menace from spitting and 
from vitiation by smoke are cases in point. Pure air is one of the primary 
necessaries of life, but only a small fraction of our countrymen actually enjoy 
this boon. To this end proper drainage and garbage removal and clean streets 
are needed. The transmission of disease by insects, flies, and vermin needs to 
be checked. A constant cause of mortality, among infants especially, is an im- 
pure milk supply. The same danger exists in other dairy products, cream, 
butter, cheese, and ice cream. In Washington, owing apparently to the enact- 
ment of a law in 1895 regulating the sale of milk, the death rate from diarrhea 
and inflammation of the bowels among children under 2 years of age was re- 
duced from 160 or 170 to 135, then 109, 104, and in 1906 to 97. Similar reports 
come from many other cities in this country and abroad. 

Sec 2. State hygiene. — The regulation of the labor of women and children 
is usually a state matter. It has been suggested by Doctor Stiles that every 
woman should be allowed once a month to leave a factory without being asked 
questions or losing wages. The employment of mothers before and after child- 
birth should be prohibited, as it is now in a number of European countries. 
This single reform would help greatly to conserve the vitality of the next 
generation. Child labor in the South is in many cases the lesser of two evils, 
the other being exposure to the hook-worm disease on polluted farms. In 
these cases, the abolition of child labor should be preceded by the abolition of 
hook-worm disease. Hours of labor have been steadily decreasing, and should 
be decreased further. Accidents are unnecessarily frequent on our American 
railroads, as well as in industrial establishments. Statistics do not exist for 
the latter. Special trades have special dangers. Among such trades are those 
using lead and other dangerous poisonous chemicals, as well as the dust- 
producing trades which tend to pulmonary troubles. The dark room tenements 
are a common means in our large cities of depleting national vitality. 

Sec 3. Federal hygiene. — This includes quarantine, the inspection of im- 
migrants and exclusion of those with infectious diseases, administration of 
government hospitals, of pure-food laws and meat inspection, and cooperation 
with state boards of health in fighting yellow fever, bubonic plague, etc. 
Federal power needs extension, however. Our interstate railroads should be 
improved in respect to the sanitation of sleeping cars, smoking cars, etc. 

The movement to secure a more intelligent national organization of health 
is now being pushed by the President, President-Elect, and Members of Con- 
gress, and has found expression in the recent platforms of both political parties. 
What is needed is that the Federal Government should make the national 
capital a model of sanitation, should provide for more investigation in health 
matters and the dissemination of information on the prevention of tuberculosis, 
etc., should cooperate further with state and municipal authorities, and should 
check the pollution of interstate streams and prevent the transmission of dis- 
ease-bearing meats or other food from one State to another. Lastly, it should 
secure, through whatever constitutional means exist, some method of collecting 
statistical information as to our national mortality and morbidity. Our short- 
comings in this respect are now a national disgrace. There is no accurate 
record of births in any part of the United States, and that of deaths includes 
less than half our population. As a statistician has said of one of the States, 



fisher.] NATIONAL. VITALITY. 629 

" It buries its dead people with no more ceremony than it buries its dead dogs." 
Obviously, no intelligent control of epidemics and other diseases can be made 
unless the facts in regard to those diseases are known ; in other words, unless 
there exist mortality and morbidity statistics of real value. 

ST7MMABY OF CHAPTER VIII — CONSERVATION THROUGH SEMIPUBLIC HYGIENE. 

Section 1. Medical research and instruction. — Semipublic hygiene comprises 
that relating to institutions and the medical profession. The hygiene of the future 
must depend more on discoveries in preventive medicine than on any other 
single factor, and institutions such as the Pasteur Institute, the Rockefeller 
and the Carnegie institutes, and the research laboratories of the Government 
and universities offer the most promising means of increasing this most useful 
and practical of all human knowledge. The knowledge is dispensed through 
medical schools in the training of physicians. These schools are improving so 
as to introduce more of hygiene and preventive medicine. We are still far, 
however, from having facilities for training public health officers, or giving 
them such a degree as D. P. H. (diploma of public health), as is given in 
England. 

Sec 2. The medical profession. — Antiseptic surgery has in the last century 
been the greatest triumph of the medical profession, and has given it a greater 
prestige than ever before. It has greatly reduced the mortality from opera- 
tions, and is illustrated by the figures in army operations. The mortality of the 
wounded in the Crimean war among English troops was 15 per cent. The 
mortality in the Transvaal war, 1900-1901, was less than 6 per cent. 

In the practice of medicine, the tendency is progressively to give up the use 
of violent drugs and to depend more on hygiene. Through the modern fight 
against tuberculosis, physicians have come to prescribe fresh air in their prac- 
tice generally. They are now turning in like manner to exploit the resources 
of diet, exercise, bathing, and mental hygiene. 

There is danger that these new fields will be preempted by quacks. Many 
quacks to-day, far from using patent medicines, oppose the use of any drugs 
whatever. In order that modern hygiene shall be applied by trained physicians, 
it is necessary that they provide more facilities in this direction. The leaders 
of the profession are making every effort to raise all members of their profes- 
sion to their own high standard. This standard not only aims to prevent mal- 
practice and unethical operations, but to set an example to the people in public 
service and in personal hygienic living. 

Sec 3. Institutional hygiene. — Hospitals have done much to prevent disease 
by segregating infectious cases. Institutions for the deaf and blind and other 
defectives have led to a better utilization of their powers. Institutional care of 
the insane has done much, too, but can do more. Mental hygiene as a whole needs 
to be more carefully studied and taught in all its relations — heredity, alcohol, 
syphilis, and environment. 

The modern sanitarium has become a useful institution for prevention of 
serious illness, as distinct from the hospital, of which the function has been to 
cure. Department stores, hotels, and other commercial institutions are install- 
ing ventilating and other hygienic apparatus. The churches are also taking 
part in the health movement, especially the Emmanuel Church in Boston. 

Sec 4. School hygiene. — The hygiene of school children is especially impor- 
tant because of its application to human life in its early stages. There is a 
world-wide movement, led by Switzerland and some other countries of Europe, 
to obtain and apply knowledge of how to educate the mind without weakening 
the body. As it is, school children are especially exposed to contagious dis- 
eases, which under present conditions often sweep through a whole school be- 
fore the local health board even hears of it. Quite as serious, if not more so, is 
the protecting of school children from imperfect seating, lighting, ventilation, 
and sanitation. 

Backward children, with defects of eye, ear, nose, or throat, are numerous, 
but experiments have shown that the majority could be improved both in intel- 
lect and in morals. 

In respect to school hygiene, it is not sd much lack of knowledge as lack of 
application of knowledge which is at fault. In order to find and then correct 
defects of eyes, ears, teeth, etc., and properly apply our knowledge, medical 
inspection is necessary. Such inspections as have been made disclose an 
astonishing amount of ill health, the percentage of morbidity being from 20 to 
60 per cent. The committee on physical welfare of school children in New 



630 REPORT OF NATIONAL, CONSERVATION COMMISSION. 

York found that 66 per cent needed medical or surgical attention or better 
nourishment ; 40 per cent needed dental care ; 38 per cent had enlarged glands 
of the neck ; 31 per cent had defective hearing ; 18 per cent had enlarged tonsils. 

Eye strain is a particular evil of civilization, and makes its first appearance 
In school when the scholar tries to accommodate the eye to the short range 
which reading requires, but for which the eye mechanism is not well adapted 
by nature. The evil effects of eye strain are not confined to that organ, but ex- 
tend to the whole nervous system, and indirectly to the whole organism. 
Doctor Gould, who has made a special study of this subject, goes so far as to 
maintain that " eye strain is the chief source of the functional diseases of our 
citizens." 

At present medical inspection is the exception rather than the rule. Only 70 
cities in the United States outside of Massachusetts, and 32 cities and 321 
towns in Massachusetts, have systems more or less complete. New York em- 
ploys 150 physicians, who visit each public school once a day to examine chil- 
dren set aside for that purpose by the teacher. In Providence a fresh-air 
school for children suffering from tuberculosis has been established. The cost 
of the school per capita is about 50 per cent more than the ordinary schools, 
but the results justify the expenditure. 

Our scholars are being seriously injured by nervous overstrain. Probably 
this is not because too much work is being required, but because the perform- 
ance of this work is not accomplished economically. Some experiments seem 
to indicate that children could accomplish as much intellectually with far less 
dissipation of nervous energy if they were in the schoolroom about half of the 
time now spent there. High pressure and long hours are bad economy in 
schools as in factories. 

Playgrounds conserve child vitality and are far superior to formal gymnastics. 
They provide physical training which accords with child instincts, and keep the 
child out of mischief and often out of jail. Here, as elsewhere, the suppression 
by civilized and urban life of the instinct for play and amusement is re- 
sponsible for much of what we call " crime " and " depravity." In school children 
should not only be surrounded by hygienic environment, but should be taught 
the value of hygiene. The suggestion of an annual " health day " or " health 
week " may prove a fruitful one for this purpose. 

Sec. 5. Voluntary and business organizations. — Societies to prevent the spread 
of tuberculosis, social diseases, insanity, etc., or to advocate labor or health 
legislation (state and national), are now numerous and active. It is being 
found that philanthropy and profit are not always antagonistic. Labor organi- 
zations are connecting the health movement with the eight-hour movement. 
Farsighted employers are providing social secretaries to watch over the health, 
comfort, and happiness of their employees, and are often eager for practical 
suggestions in these matters. 

Corporations that have installed apparatus for ventilation and sanitation, 
even sometimes for the benefit of their machinery rather than their employees, 
have in known instances gotten back the cost in lessened illness and greater 
efficiency of work. 

An interesting experiment near Paris was that of a mill employing 44. men 
and 75 women and children. Largely through the services, instruction, and 
suggestions of a medical officer there was not a single death in three years. 

The temperance reform has to-day a powerful impulse in the demands by 
employers for more efficient labor and by the public for greater safety in 
travel. Locomotive engineers, conductors, and ship captains who drink can not 
get employment. 

Life-insurance companies may possibly in the future realize their opportunity 
to make financial gains by participation in the health movement. 

Finally, one of the greatest potential agencies for bringing about health re- 
form is the public press. It is already interested and active in the movement, 
although the good it does is often undone by inserting quack advertising. This 
not only does direct harm, but often ties the hands of the editor, preventing 
him from expressing any disapproval of nostrums, however injurious or 
immoral. 

SUMMARY OF CHAPTEB IX CONSERVATION THROUGH PERSONAL HYGIENE. 

Section 1. Its importance. — Personal hygiene is not only of direct importance 
to the individual, but furnishes the public opinion from which, and from which 
alone, sound public and semipublic hygiene can spring. Public hygiene will be 



fishbr.] NATIONAL. VITALITY. 631 

ineffective unless supported by personal hygiene. The milk and water supply of 
a city may be ideal as supplied at a dwelling, but may be carelessly contami- 
nated there. Observation shows that many of the world's most vital men and 
women have practiced hygiene and often thereby turned weak constitutions 
into strong ones. Cornaro, the Venetian nobleman, about to die at 37, adopted 
the " temperate life," taking especial care not to overeat. He lived to be nearly, 
or quite, 100. 

Sec. 2. Branches of personal hygiene. — Personal hygiene comprises hygiene 
of environment (air, soil, dwellings, clothing), hygiene of nutrition, and hygiene 
of activity. The ideal conditions of health require purity in air, purity and 
proper use of food, and a proper balance between mental and physical activity, 
rest, and sleep. The present world-wide interest in personal hygiene and 
physical education is not due to any startling discoveries, but to the rediscovery 
of the importance of truths long insisted upon by the medical profession. 

Sec. 3. The hygiene of environment. — The prime factor in environment is the 
atmosphere. Originally man was doubtless an outdoor animal. Civilization has 
brought him an indoor environment, and with it tuberculosis. Experiments in 
hospitals have shown that the agitation of the air by dry sweeping greatly 
increases bacteria. Air in a confined room may be contaminated by chemicals 
contained in wall paper, plaster, or mortar. The one place in which the indi- 
vidual has most control over his air supply is the bedroom. The fashion now of 
sleeping with wide-open windows, or even out-of-doors, is certain to improve 
American vitality. The windows of living and work rooms also may be open 
even in winter if a window board is used to deflect the air upward and prevent 
a cold stratum forming on the floor. The outdoor life or the abundant use of 
fresh air is an almost certain preventive of colds. This fact was commented 
upon by Franklin over a century ago, and has been rediscovered many times 
since, especially in the experience of army troops. The evils of bad air are not 
confined to its chemical content. A room is sometimes "close" simply because 
it is hot or overmoist or devoid of any air current. 

The effect of air on the skin and of radiation of heat from the body is im- 
portant. Consequently, a proper use of air involves a proper use of clothing, 
which needs to be both porous and light. 

Closely connected with air hygiene is the hygiene of light. " Where sun and 
air enter seldom the physician enters often." The lighting of dwellings and 
schoolrooms is especially important with reference to the eyes. This is true also 
of even the color and texture of the printed page we read. Probably one-fourth 
of all educated people in America suffer from disturbances due more or less to 
eye strain and its numerous indirect effects. 

Sec. 4. The hygiene of nutrition. — The scientific study of diet has only just 
begun, and few authoritative results can yet be stated. That diet has a dis- 
tinct relation to endurance has been rendered probable by many investigations, 
which seem to show in particular that avoidance of overeating, and especially 
of excess in protein, and thorough mastication are wholesome rules. In the 
choice of foods the individual must be given a wide latitude. His own instinct, 
restored and educated by avoiding food-bolting which blunts it, will probably 
be a truer guide than the wisest of physiologists. Diseased foods, such as 
oysters polluted with sewage, may transmit typhoid and other maladies. 

Sec S. Drug haoits. — Poisons, whether taken into the body or produced 
within, are injurious. The commonest form of intoxication is alcoholic. Its 
evils are becoming more apparent than ever before. As Metchnikoff says, it 
lowers the resistance of the white corpuscles, which are the natural defenders 
of the body. It predisposes to tuberculosis and numerous other diseases. 
The findings of the " Committee of Fifty " for the investigation of the liquor 
problem are important evidence of the evils of the use of alcohol, and these 
have not received the attention which they deserve. Absinthe in France is 
being recognized now as a distinct menace to the nation, and in Germany 
there is a tendency toward a lessened use of alcohol in all its forms. But the 
movement against the abuse of alcohol has reached its highest point in 
America. 

The evils of tobacco are less and are less appreciated. Its stunting effects 
on the growing child are especially harmful. 

Sec. 6. Activity hygiene. — It is an encouraging sign of the times that baths 
are coming more into vogue, both through the private bath tub for the wealthy 
and the public baths for the poor. During the last generation the importance 
of exercise has come to be acknowledged, due largely to the growth of modern 
athletics. The athletic ideal of the Greeks was, however, higher than that 



632 REPORT OF NATIONAL CONSERVATION COMMISSION. 

which now prevails in this country. Overexertion, physical and mental, is one 
of the chief American faults. The danger signal of fatigue is seldom observed, 
and the instinct for recreation and amusement is often stifled. 

Sec. 7. Sex hygiene. — Undue reticence on this subject is responsible for the 
general ignorance as to the extent to which the abuse of the sex relation is in- 
juring this and every nation, physically, mentally, and morally. Syphilis 
poisons the blood and affects all parts of the body. It makes the individual a 
" bad risk " for life insurance companies for several years, and is likely to be 
transmitted to others through a kiss or through the use of a common towel, 
while the danger of transmitting from husband to wife, or vice versa, continues 
for many years. Syphilis is one of the few really hereditary diseases, and the 
saddest of all facts connected with it is that the guilty parent may escape and 
the innocent children suffer. Gonorrhoea, while usually cured without ap- 
parent impairment of health, destroys fertility, and for years after it has ap- 
parently ceased may be rearoused. It is responsible for a large number of 
the cases of infantile blindness and for a larger percentage of many of the 
serious troubles of women. The social diseases, while seldom assigned as a 
cause of death, are known to predispose to other diseases and greatly to 
shorten life. 

Sec 8. Personal hygiene in general. — The cumulative effect of hygiene, or of 
lack of hygiene, needs emphasis. Breathing, eating, working, and sleeping are 
matters of daily habit. If they are wrong, the evil, however slight, being re- 
peated every day for many years, produces cumulative effects more subtle, but 
often more powerful, than the effects of sudden infection or accident. 

SUMMARY OF CHAPTER X — ARE HYGIENIC MEASURES EUGENIC? 

Section 1. The prolongation of weak lives. — The question has been raised 
whether reduction in infant and child mortality will not weaken rather than 
strengthen the race by interfering with natural selection and favoring the sur- 
vival of the unfit. It is pointed out that the mortality at later ages of life has 
not decreased, as has that in the earlier ages. There is probably, however, a 
sufficient explanation of this in the fact that the improvement in hygienic living 
has not as yet affected adults as much as children. Parents are quick to apply 
for the benefit of their children new methods of preventing disease, such as 
sterilizing milk, but do not take the same precautions for themselves. The 
hurry and stress of modern life has in fact tended to produce in some respects 
more unhygienic habits among adults than prevailed under the simpler condi- 
tions of a generation ago. 

Sec 2. Children's diseases impair both fit and unfit. — It must be borne in mind 
also that the same children's diseases and other causes which tend to kill the 
unfit child also tend to injure the proper development of the fit. Consequently 
a lessening of children's diseases will have the effect of not only prolonging 
weak lives, but also of prolonging and developing the strong. Statistics, so far 
as available, appear to show that where infant mortality is the highest, mor- 
tality at all ages is high. 

Sec 3. Fitness is relative to environment. — What is sometimes called degen- 
eration does not deserve that name. A lessening of physical strength, for 
instance, can not be called degeneration if conditions under civilization do not 
require the same physical strength as our barbarian ancestors needed. It is 
adaptation to existing conditions which measures fitness. 

Whatever danger of degeneration there may be from the care of the insane 
and defective classes can be avoided if the health ideals of the nation are strong 
and broad enough to meet the situation, for with these high health ideals will 
come a demand which will prevent the perpetuation of the unfit and through 
the mere force of public opinion lead in general to healthier marriages. 

Summary of Part IV. — Results of conserving life. 

SUMMARY OF CHAPTER XI — PROLONGATION OF LIFE. 

Section 1. Life is lengthening. — So far as we can judge from statistics of the 
average duration of life, it has been on the increase for three hundred and fifty 
years, and is now increasing more rapidly than ever before. During the seven- 
teenth and eighteenth centuries the increase was at the rate of about four years 
per century; during the first three-quarters of the nineteenth century the rate 
was about nine years. At present in Massachusetts life is lengthening at the 



usher.] NATIONAL. VITALITY. 633 

rate of about fourteen years per century; in Europe about seventeen; and in 
Prussia, the land of medical discovery and its application, twenty-seven. In 
India, where medical progress is practically unknown, the life span is short 
(twenty-five) and remains stationary. 

Sec. 2. Table showing further practicable prolongation. — It is possible to 
estimate the effect on the length of life of the partial elimination of various 
diseases. Using the statistics, experience, and estimate of 18 physicians as 
to the preventability of each of the list of 90 causes of death, we find that the 
length of life could easily be increased from forty-five to sixty, an increase of 
one-third, or fifteen years. This would result in a permanent reduction in 
death rate of about 25 per cent. The principal reductions would be from infan- 
tile diarrhea and enteritis, over 60 per cent of which could be prevented, with 
the result of an addition to the average length of life of 2.32 years. Broncho- 
pneumonia, also an infant disease, could be prevented to the extent of 50 per 
cent, whereby life would be lengthened by 0.60 year. Meningitis, which is 
usually fatal at the age of two, could be prevented by at least 70 per cent, and 
this prevention would lengthen the average life by 0.60 year. Eighty-five per 
cent of death by typhoid fever is unnecessary, and if avoided would lengthen 
life at least 0.65 year. It would be feasible to prevent at least 75 per cent of 
cases of tuberculosis of the lungs, and thereby to lengthen life by about two years. 
If the deaths from violence were reduced only 35 per cent, human life would be 
increased by 0.86 year. The prevention of 45 per cent of cases of pneumonia 
would lengthen life by 0.94 year. These seven diseases alone could easily be 
reduced by these amounts so as to lengthen life by eight years. This could be 
done simply through insistence by the public on pure milk, pure water, pure 
air, and reasonable protection from accidents. 

Sec. 3. Diagram showing' effect of prolongation at different ages. — If we take 
the diagram representing the life table of Massachusetts for 1893-1S97, we may 
use it as the basis for constructing an ideal curve to show the effect of preven- 
tion if applied according to the ratios of prevention given in the preceding 
table. The results agree substantially with those found in the table and show 
that about thirteen or more years could easily be added to the average duration 
of life. The diagram also shows the extent to which the additional life would 
fall in different ages. The per cent of life which would fall to the ages between 
17* and 60, taken as the working period, would remain the same, namely, about 
55 per cent. 

Sec. 4. Fifteen years a safe minimum estimate of prolongation possible. — 
The estimate of fifteen years is a minimum because, first, it takes no account 
of future medical discoveries, such as a method of curing or preventing cancer 
and of postponing old age, as would Metchnikoff ; second, it takes little account 
of the cumulative influence of hygiene. The full benefit of hygiene can not be 
felt until it is practiced throughout life, and not at the approach of specific 
danger. Most so-called " causes " of death are merely the last straws which break 
the camel's back. When a pure water supply prevents deaths from typhoid 
fever, it prevents two or three times as many deaths from other causes. Third, 
it takes no account of the racial effects of new health ideals leading, in a general 
way, as they must, to healthier marriages. 

Sec 5. Need of lengthening human life. — With increase of knowledge the 
period of education or preparation for life must constantly increase. This fact 
creates a need for a longer life, with the later periods of life increased in pro- 
portion. The result of such a prolongation will be not the keeping alive of 
invalids, but the creation of a population containing a large number of vigorous 
old men. Metchnikoff says, " The old man will no longer be subject to loss 
of memory or to intellectual weakness; he will be able to apply his great 
experience to the most complicated and most delicate parts of the social life." 

Sec 6. The normal lifetime. — It is usually recognized that human life is 
abnormally short, but no exact determination has ever been made of what 
constitutes a normal lifetime. Flourens maintains that a mammal lives five 
times the length of its growing period, which would mean, since the growing 
period for man does not cease until about 30, a normal human lifetime of 
one hundred and fifty years. Another method of estimating normal life is to 
reckon the length of normal life as the time when old age now sets in, 83 years. 
But clearly, if Metchnikoff is right in thinking that old age itself is abnormal, 
the normal lifetime must exceed 83. Many remarkable cases of longevity are 
on record, but most cases of reputed centenarians are not authenticated. 
Drakenburg's record was authentic, and he lived to be 146. Mrs. Wood, of 



634 KEPOET OF NATIONAL CONSERVATION COMMISSION. 

Portland, Oreg., recently died at 120. To what extent these exceptional cases 
could be made common can not, as yet, be known. 

SUMMARY OF CHAPTER XII — THE MONET VALUE OF INCREASED VITALITY. 

Section 1. Money appraisal of preventable wastes. — Doctor Farr has esti- 
mated the net economic value of an English agricultural laborer at various times 
of life by discounting his chance of future earnings after subtracting the cost 
of maintenance. On the basis of this table we may construct a rough estimate 
of the worth of an average American life at various ages, assuming that only 
three-fourths of those of working age are actually earners of money or house- 
keepers. It gradually rises from a value of $90 in the first year to $4,200 at 
the age of 30, and then declines until it becomes negative for the higher ages. 
This estimate assumes $700 per year as the average earnings in middle life. 
This is largely conjecture, but is regarded as a very safe estimate. Applying 
this table to the existing population at various ages in the United States, we 
find that the average value of a person now living in the United States is 
$2,900, and the average value of the lives now sacrified by preventable deaths 
is $1,700. The latter is smaller than the former because the age of the dying 
is greater than the age of the living. Applying the $2,900 to the population of 
eighty-five and a half millions, we find that our population may be valued as 
assets at more than $250,000,000,000; and since the number of preventable 
deaths is estimated at 630,000, the annual waste from preventable deaths is 
630,000 times $1,700, or about $1,000,000,000. This represents the annual pre- 
ventable loss of potential earnings. 

We saw in Chapter III that there are always 3,000,000 persons in the United 
States on the sick list, of whom about 1,000,000 are in the working period of 
life and about three-quarters are actually workers and must lose at least $700, 
which makes the aggregate loss from illness more than $500,000,000. Adding 
to this another $500,000,000 as the expense of medicines, medical attendance, 
special foods, etc., we find the total cost of illness to be about $1,000,000,000 
per year, of which it is assumed that at least one-half is preventable. Adding 
the preventable loss from death, $1,000,000,000, to the preventable loss from 
illness, $500,000,000, we find one and a half billions as the very lowest at which 
we can estimate the preventable loss from disease and death in this country. 
The true figures from the statistics available may well amount to several times 
this figure, but when statistics are based partially on conjecture, they need to 
be stated with special caution. 

Sec. 2. The cost of conservation. — In Huddersfield the annual deaths of in- 
fants for ten years had been 310. By systematic education of mothers, the 
number in 1907 was reduced to 212. The cost of saving these 98 lives was 
about $2,000, or about $20 each. Gen. Leonard Wood declared that the discovery 
of the means of preventing yellow fever saves annually more lives than were 
lost in the Cuban war. The hook-worm disease in the South impairs the 
earning power of its workmen by 25 or 50 per cent. To restore this earning 
power costs, by curing this disease, on an average, less than $1 for each case. 
These and other examples show that the return on investments in health are 
often several thousand per cent per annum. Probably no such unexploited op- 
portunity for rich returns exists in any other field of investment. An actuary 
suggests that if insurance companies should combine to contribute $200,000 a 
year for the purpose of improving the public health, the cost would be one- 
eighth of 1 per cent of the premiums, and it would be reasonable to expect a 
decrease in death claims of much more than 1 per cent. Even this 1 per cent 
would make a profit of more than seven times the expense. 

SUMMARY OF CHAPTER XIII — THE GENERAL VALUE OF INCREASED VITALITY. 

Section 1. — Disease, poverty, and crime. — Money estimates of waste of life 
are necessarily imperfect and sometimes misleading. The real wastes can only 
be expressed in terms of human misery. Poverty and disease are twin evils 
and each plays into the hands of the other. From each springs vice and crime. 
Again, whatever diminishes poverty tends to improve health, and vice versa. 

Sec. 2. Conservation of natural resources. — The conservation of our natural 
resources — land, raw materials, forests, and water — will provide the food, 
clothing, shelter, and other means of maintaining healthy life, while the con- 
servation of health likewise tends in many ways to conserve and increase 



fisher.] NATIONAL VITALITY. 635 

wealth. The more vigorous and long-lived the race, the better utilization it will 
make of its natural resources. This will be true for two reasons in particular : 
First, the greater inventiveness or resourcefulness of vigorous minds in vigorous 
bodies. Civilization consists chiefly in invention and the most progressive nations 
are those whose rate of invention is most rapid. Second, the greater foresight 
and solicitude for the future. As it is usually the normal healthy man who 
provides life insurance for his family, so it will be the normal healthy nation 
whch will take due care of its resources for the benefit of generations yet 
unborn. 

SUMMARY OF CHAPTER XIV — THINGS WHICH NEED TO BE DONE. 

Section 1. Enumeration of principal measures. — Federal, state, and municipal 
boards of health should be better appreciated and supported. Their powers of 
investigation, administration, and disseminating information should be en- 
larged. School hygiene should be practiced, and personal hygiene more empha- 
sized. The multiplication of degenerates should be made impossible. 

S. Doc. 419, 61-2—2 



INTRODUCTION". 

At the conclusion of his White House address on the " Conserva- 
tion of Natural Kesources," President Roosevelt said: 

Finally, let us remember that the conservation of our natural resources, 
though the gravest problem of to-day, is yet but part of another and greater 
problem to which this nation is not yet awake, but to which it will awake in 
time, and with which it must hereafter grapple if it is to live — the problem of 
national efficiency. 

The conditions on which national efficiency depend may be classi- 
fied under three heads: Those relating to physical environment, 
those relating to social environment, and those relating to human 
nature. Under the first head comes the problem of the conservation of 
land, forests, minerals, and water. The second comprises social ques- 
tions, whether political, economic, or religious. 'The third covers 
the study of the characteristics of man himself — physical, mental, and 
moral. 

This report falls under the third head, concerning as it does vital- 
ity, the measure of life itself, and the basis of all human qualities. 
The object is to review briefly the condition of American vitality, 
contrasted with the vitality of other nations; to show the extent to 
which it may be increased; and to point out the value of such an 
increase in years of life, enjoyment of life, and economic earnings. 

The world is gradually awakening to the fact of its own unprovabil- 
ity. Political economy is no longer the " dismal science," teaching 
that starvation wages are inevitable from the Malthusian grow T th 
of population, but is now seriously and hopefully grappling with 
the problem of abolition of poverty. In like manner hygiene, the 
youngest of the biological studies, has repudiated the outworn doc- 
trine that mortality is fatality, and must exact a regular and in- 
evitable sacrifice at its present rate year after year. Instead of this 
fatalistic creed we now have the assurance of Pasteur that " It is 
within the power of man to rid himself of every parasitic disease," 
as well as the optimistic writings of Metchnikoff and others. 

Many evidences of a world-wide awakening to the importance of 
improving human vitality can be given. Among them are the recent 
English parliamentary report of the interdepartmental committee 
on physical degeneration (prompted by the fact that the English 
army recruits were decreasing in stature) ; in America, the many 
societies and congresses to prevent and control tuberculosis, insanity, 
alcoholism, social diseases and vice, and infant mortality; the growth 
of preventive sanatoria, dispensaries, and similar institutions; the 
establishment of numerous journals of preventive medicine, both 
technical and popular; the increased attention to the subject of 
health in the public press; the spread of athletics and the physical 
training movement ; the growth of the custom among city people to 

636 



fisher.] NATIONAL. VITALITY. 637 

organize country clubs, and the increasing popularity of golf and 
similar recreations; the constant agitation and legislation m refer- 
ence to child labor, slaughterhouses, impure foods, milk supply, and 
water contamination; the increased vigilance of health boards; the 
growth of sick-benefit associations and insurance among working 
men; the efforts toward improving the sanitary surroundings and 
hours of labor of workmen, and especially of women and children, 
and, finally, the movement to secure a national organization of health 
at Washington. 

A number of universities are supporting special investigations in 
physiology, hygiene, and preventive medicine. Some schools also 
have placed the allied subjects of domestic science and dietetics on 
their curricula, while physical education is receiving constantly in- 
creasing attention. Within a generation every important college, 
school, and branch of the Young Men's Christian Association has 
come to have a gymnasium and classes in gymnastics. Research insti- 
tutions are being established, such as the Rockefeller Institute for 
Medical Research, the fund established by Mrs. Sage to study dis- 
eases of old age, and the Memorial Institute for Infectious Diseases. 
The home -economics movement is rapidly growing and seems destined 
to improve greatly the management of American homes. 

The practice of medicine, which for ages has been known as the 
" healing art," is undergoing a gradual but radical revolution. The 
change is based on the conviction that an ounce of prevention is 
worth a pound of cure. As teachers and writers on hygiene, as 
trainers for athletes, as advisers for the welfare departments of large 
industrial plants, and in many other directions, physicians are find- 
ing fields for practicing preventive medicine. There is a still higher 
stage of medical science than that of fighting or preventing disease 
in the individual — the stage which has been called "biological engi- 
neering," i. e., the study of the conditions under which the individual 
may reach his highest efficiency. In the development of this science 
physicians are turning from private practice to public service and 
are acting as health officers in federal, state, and city governments, 
as heads of sanatoria and as medical inspectors of schools, factories, 
mines, and shops. Even the family physician is in some cases being 
asked by his patients to keep them well instead of curing them after 
they have fallen sick. 

Finally, we have also the suggestion by Sir Francis Galton of the 
new science of eugenics, which seeks to study the hereditary condi- 
tions of human vitality. He has established a research fellowship 
on the subject at the University of London. Already Karl Pearson 
and others have made valuable contributions to the study of human 
degeneration, the effect of tuberculosis on the race, the comparative 
number of offspring of various classes, and the extent to which 
mating is " assortative," so that like marries like. 

With all these facts in view it requires no great prophetic vision 
to see that among the rising generation there will be a great move- 
ment to conserve human life and health. The power and success of 
this movement will depend upon the realization of its stupendous 
importance. A chief object of this report is, in a conservative and 
cautious manner, to help make this importance clear. 



Part I.— THE LENGTH OF LIFE VERSUS MORTALITY. 

Chapter I. — The length of life. 

Section 1. — In different places. 

By those who have never considered the problem, death and disease 
are accepted as a matter of course. In individual cases it is recog- 
nized that a death or an illness might have been prevented, but the 
idea that the death rate could be changed in any appreciable degree, 
or controlled, is quite foreign to the mind of the average man. 
Charles Babbage wrote: "There are few things less subject to fluctua- 
tion than the average duration of life of a multitude of individuals. 

If this statement were correct, we should find the average duration 
of life & and the death rate substantially the same in different places 
and at different times. The facts do not conform to this view. 
Modern life tables show that the average length of life in the leading 
countries of the world varies remarkably, as the following figures 
will illustrate/ 

Modern duration of life., 



Country. 




Females. 



Sweden, 1891-1900 

Denmark, 1895-1900 

France, 1898-1903 

England and Wales, 1891-1900 

United States (Massachusetts, 1893-1897) a 

Italy, 1899-1902 

Prussia, 1891-1900 

India, 1901* 



53.6 
53.2 
49.1 
47.7 
46.6 
43.1 
44.5 
24.0 



• Samuel W. Abbott, M. D. : " Vital Statistics of Massachusetts for 1897," Thirtieth 
Annual Report of the State Board of Health of Massachusetts, 1898. 

* Statistiques Generale de la France : Statistiques Internationales, etc., 1907, p. 566. 
See also J. A. Baines, " The Peradventures of an Indian Life Table," Journal Royal Sta- 
tistical Society, 1908, Vol. LXXI, part 2, p. 310, where the average duration of life for 
males is given as 23.6. 

When we consider that the average duration of life in India is 
scarcely more than one-half that of France and less than one-half 

° Charles Babbage: A Comparative View of the Various Institutions for the 
Assurance of Lives, p. 15. London, 1826. 

6 By average duration of life or the life span is meant the average length of 
life among a large number of persons born taken at random. It is not the same 
as the average age at death in a community during a year, since that com- 
munity may contain an abnormally large proportion of infants, or of any other 
" age group." 

c Some of the figures, especially those for India, rest on imperfect data, but 
they are believed to be sufficiently accurate for general comparison, 

638 



fisher.] NATIONAL, VITALITY. 639 

that of Sweden, we must conclude that the length of human life is 
dependent on definite conditions and can be increased or diminished 
by a modification of those conditions. 

Section 2. — At different times. 

Striking corroboration of this conclusion is found as soon as we 
compare the average duration of life at different periods of time. 
The earliest attempt to discover a law of human mortality appears to 
be that of Ulpian, a Roman pretorian prefect, about 220 A. D. The 
meaning of his table is somewhat doubtful, but it is assumed to refer 
to " expectation of life," which for a£es up to 20 is given as thirty 
years.* 

This estimate is so crude and vague as to be of little value for 
comparative purposes. Professor Finkelnburg ? of Bonn, estimates 
that — - 

The average length of human life in the sixteenth century was only between 
eighteen and twenty years, and that at the close of the eighteenth century it 
was a little over thirty years, while to-day it is between thirty-eight and forty 
years. 6 

In Geneva the records go back over three centuries showing the fol- 
lowing life span : c 

16th century 21.2 

rrth century 25.7 

18th century 33.6 

1801-1883 1 39.7 

Here we see an increase in the span of life of 100 per cent in three 
or four centuries. The last few decades, moreover, tell a striking story 
of increase. It is one of the boasts of the nineteenth century that the 
splendid medical and scientific advances of that period have aided in 
a distinct lengthening of life. 

In 1693 the British Government borrowed money by selling an- 
nuities, and in 1790, a century later, it did the same thing. While 
the first venture proved satisfactory, the second caused a great loss to 
the Government, owing to the improvement in longevity which had 
taken place, and which was estimated, for the annuitant class, at 
20 years. d 

If we compare Ogle's English life tables for 1871-1881 with those 
of Farr for 1838-1854, we find an increase in life span of 1.4 years 
for males and 2.8 for females.** 

a See Irving Fisher : Mortality Statistics of the United States Census, Publica- 
tions of the American Economic Association, Monograph on Federal Census, 
1899, p. 157. Taken from Assurance Magazine, VI, p. 314 ; note. 

& George M. Kober, M. D. : " Conservation of Life and Health by Improved 
Water Supply," publications of conference on the conservation of natural re- 
sources, 1908, p. 23. Washington, D. C., privately published. From Finkeln- 
burg's " Organisation der offentl. Gesundheitsphlage in der Kulturstaaten " in 
Handbuch der Hygiene, 1893. 

c From Mallet in "Annales d' Hygiene," XVII, 169 ; quoted by Dr. Edward 
Jarvis, " Political Economy of Health," in Fifth Annual Report, Mass. Board of 
Health, 1874. 

d See Dr. Southward Smith, Transactions British Social Science Association, 
1857, p. 498, quoted by Dr. Edward Jarvis, ibid. 

e R. Mayo-Smith; Statistics and Sociology, p. 178. New York (Macmillan), 
1895. 



640 EEPORT OF NATIONAL CONSERVATION COMMISSION. 

A still greater improvement has been effected since Ogle's figures 
of 1871-1881 : 

Lifetime in England and Wales : 

Males — 

1838-1854 39. 9 

1891-1900. 44.1 

Females — 

1838-1854 41. 8 

1891-1900 47. 8 

Similar improvements are observable in other countries. 

Lifetime in France: 

Males — 

1817-1831 38. 3 

1898-1903 45. 7 

Females — 

1817-1831 40. 8 

1898-1903 49. 1 

Lifetime in Prussia : 

Males — 

1867-1877 35. 3 

1891-1900 41. 1 

Females — 

1867-1877 37.9 

1891-1900 44. 6 

Lifetime in Denmark : 

Males — 

1835-1844 42. 6 

1895-1900 50. 2 

Females — 

1835-1844 44. 7 

1895-1900 53. 2 

Lifetime in Sweden : 

Males — 

1816-1840 39. 5 

1891-1900 50. 9 

Females — 

1816-1840 . 43. 5 

1891-1900 53. 6 

It is difficult to obtain American life tables that go far enough back 
into history to display increases in the life span similar to those just 
presented; yet comparisons of Abbott's Massachusetts life tables for 
1893-1897 with Elliott's Massachusetts tables for 1855 and Wiggles- 
worth's Massachusetts and New Hampshire life tables of a century 
ago give us a progressive increase from 35 in 1789 a to 40 in 1855 b 
and 45 in 1893-1897.° Unfortunately no tables exist for the United 
States as a whole from which similar comparisons might be made. 
Good and reliable vital statistics are among our most crying needs. 
Meech's life tables, based on the census figures of 1830, 1840, 1850, 
and 1860, showed a life span for the whole country of 42. d 

° E. Wigglesworth : " Table showing the probability of the duration, the 
decrement and the expectation of life in the States of Massachusetts and New 
Hampshire, formed from 62 bills of mortality on the files of the American 
Academy of Arts and Sciences in the year 1789." Memoir of the American 
Academy of Arts and Sciences, Vol. II, p. 133. 

6 Proceedings American Association for the Advancement of Science, 1857, 
pp. 61 and 69. . 

c Abbott, loc. cit. 

<*Levi W. Meech: System and Tables of Life Insurance, ed. of 1886, pp. 
255-259. The figures for life span at different periods given in this paragraph 
have been secured by averaging the figures for males and females. 



fisher.] NATIONAL VITALITY. 641 

The census of 1880 gave some 70 sets of life tables for different 
registration States and cities. The expectation of life for white 
males was given for Massachusetts as 44, New Jersey 46, District of 
Columbia 41, and New York City 33, but in constructing the tables 
" the census was too prodigal as to quantity and somewhat careless as 
to quality. It is difficult to separate the wheat from the chaff. The 
table should have been accompanied by a running criticism. The 
general defect was that no attempt was made to correct the deficiencies 
in the returns for infants." a The census for 1890 gives only a few 
life tables, and that for 1900 none. 

In striking contrast to these recent increases of the life span in 
progressive countries is the table for backward India, which showed 
no advance in twenty years. 6 

Lifetime in India : 
Males — 

1881 23.7 

1901 23.6 

Chapter II. — The mortality rate. 
Section 1. — Relation of longevity and mortality. 

The average duration of life and the death rate are two comple- 
mentary magnitudes. An increase in the life span means a decrease 
in the death rate, and vice versa ; in fact, in a " stationary " popula- 
tion (a population in which the annual number of deaths equals the 
annual number of births, and without emigration or immigration), 
it will be true that the average duration of life .and the death rate 
are mathematically the " reciprocals " of each other. d Thus, if the 
death rate is 20 deaths per annum for each 1,000 of population (i. e., 
twenty one-thousandths per annum), the average duration of life 
would be J^ - = 50 years. 

If this reciprocal relation between duration of life and mortality 
held true in every population, it would be easy to translate death 
rates into average duration of life, and conversely ; but unfortunately 
such a simple calculation is impracticable under conditions existing 
in America, and even in most countries of Europe. With the ex- 
ception of France, few countries have even approximately an equality 
between deaths and births and an absence of emigration and im- 
migration. In America, where the deaths are exceeded by the births, 
and where there is a large immigration of young men and women in 
the prime of life, the death rate is smaller than it would be if our 
population were " stationary." The annual death rate in the United 

a Fisher : Mortality Statistics of the United States Census, American Eco- 
nomic Association Monograph on the Federal Census, 1899, p. 160. 

6 Baines : " The Peradventures of an Indian Life Table," Journal of the 
Royal Statistical Society, 1908, Vol. LXXL, pt 2, p. 310. 

C A death rate is the ratio of the number of deaths during a year to the popu- 
lation, taken at some point in the year, usually the middle. 

d For a short explanation of this reciprocal relation, which is more fully 
explained in works on actuarial science, see Fisher : Mortality Statistics of the 
United States Census, pp. 149-150. It is interesting to see the graphic in- 
terpretation of this reciprocal relation by means of the diagram in Chapter 
XI of this Report. 



642 KEPORT OF NATIONAL CONSERVATION COMMISSION. 

States is probably about 18 per thousand of population. The 
reciprocal of this would be 1,000-1-18, or 55 years, which is altogether 
too high an estimate for the average length or life in the United 
States. 

It is possible to " correct " the death rate for " age distribution " so 
that its reciprocal will be the true average duration of life, but the 
calculation is a difficult and tedious one. We are forced, therefore, 
to get along in most cases with the " crude death rate," or the quo- 
tient of the number of deaths in a year divided by the population. 
This figure is much easier to obtain than a corrected death rate or its 
reciprocal, the average duration of life. 

Our data for death rates are far more voluminous than our data 
for the average duration of life. Although theoretically death rates 
are not an unerring indication of longevity, they furnish in practice 
very valuable information. In a general way death rates may be 
compared with each other, especially in the same community. For 
instance, a decrease in the death rate in New York City from one year 
to another is practically a certain indication of improvement in vital 
conditions. 

Section 2. — Mortality in various regions. 

Forty years ago the variations in the death rates of the different 
sections of Europe were given by Quetelet b as follows : 

Death rate per 1,000 population. 

Northern Europe 24. 3 

Central Europe 24. 5 

Southern Europe * 29. 7 

To-day the death rates of various countries compare with each 
other as in the following table : 

Modern death rates per 1,000 of population. 

Denmark (1906) 13. 5 

Sweden (1906) 14. 4 

England and Wales (1908) 15.4 

United States (registration area) (1907) 16.5 

Germany (1905) 19. 8 

France (1906) 19. 9 

Italy (1906) 20. 8 

Japan (1905) 21.9 

India (n»ales,<* 1901) 42.3 

As we found in the study of duration of life, so we find here wide 
variations from country to country. Italy presents a death rate 
larger by nearly one-sixth than that of the United States, while 
famine-tortured and plague-ridden India's mortality rate is twice 
that of France and three times the rates of Denmark and of Sweden. 

W. F. Willcox : " Death Rate of the United States in 1900," publications 
of the American Statistical Association, Vol. X, p. 155. 

6 Quetelet, Physique Sociale, Vol. I, p. 281. These figures refer to the ex- 
perience of different periods between 1801 and HS31. 

c With the exception of the figures for India, this table is taken from figures 
furnished by the Bureau of the Census. 

d Baines, loc. cit, p. 310. 



fisher.] NATIONAL VITALITY. 643 

Even the fairly homogeneous population of our registration States 
in America shows variations in death rates. 

Death rate per 1,000 population in 1900. 

Michigan 13. 9 

Vermont 17. 

Massachusetts 17. 7 

New York 17. 9 

The death rate in Michigan, at the one extreme, is thus but three- 
fourths that of New York at the other extreme. This difference may 
probably be accounted for in part by the difference in the age con- 
stitution, as the population for Michigan contains a larger propor- 
tion of population in young and vigorous life than does New York. 

Section 3. — Urban and rural mortality. 

Comparison of urban and rural death rates also gives us varia- 
tions. 6 

Death rates per 1,000 population m 1900. 

Massachusetts : 

Urban 17.9 

Rural 17. 1 

Michigan : 

Urban 15.3 

• Rural 13. 3 

New Jersey : 

Urban 18. 8 

Rural 15. 5 

Interesting comparisons may be made of the death rates of Ameri- 
can cities varying in size and location. The death rate per 1,000 of 
population in 1906 was given c as 14,2 (probably incorrect) in Chicago, 
in Boston 18.9, in New York 18.6, and in Philadelphia 19.3. Cleve- 
land, Ohio, was credited with a death rate of but 16, while Cincinnati, 
in the same State, had 20.8. The causes of such differences are not 
always attributable to variations in size. New Haven, for instance, 
a larger Connecticut city than either Hartford or New London, had a 
lower death rate in 1900 by 2.2 and 2.5, respectively, per 1,000 popu- 
lation. The differences are accounted for partly by differences in 
age constitution, partly — it is unfortunately true — by differences in 
the accuracy of the collected statistics, partly by differences in size 
and location, and partly by differences in the vigilance of the public 
and private health authorities. 

European cities show even greater variations in mortality than 
these just given for the United States. 

Twelfth Census of the United States, Vol. Ill, p. LVIII. 

6 United States Census Bulletin, No. 83, 1901. 

c Seventh Annual Census Report on Mortality Statistics, 1906. 



644 REPORT OF NATIONAL CONSERVATION COMMISSION. 

Death rates of European cities per 1,000 population, 1897.° 



Locality. 


High. 


Locality. 


Low. 


Dublin 


39.9 
36.9 
31.3 
31 


Frankfort on the Main 


15 6 


Moscow 


The Hague 


16 2 


Belfast 


Berlin 


17 


St. Petersburg 


Amstfirrla;m 


17.8 









° One must doubt, however, the accuracy of some of these figures, especially the 
Russian. The rates in Moscow and St. Petersburg in 1906 are reported as 25.8 and' 25.5, 
respectively, which do not comport with the rates for 1897. 

Section 4. — Race and condition. 

The variations in death rates among different races are well known. 
The black race, for example, always suffers a higher mortality than 
the white. In Boston during the half century from 1725 to 1774 the 
death rate per 1,000 is given as ranging from 56 to 87 for the blacks 
and only from 30 to 41 for the whites. Thus the maximum white 
death rate was lower than the minimum black death rate. a 

In 1906 the death rate per 1,000 in all registration cities having not 
less than 10 per cent colored inhabitants was 17.2 for whites and 28.1 
for blacks. 

These racial differences may be ascribed in part to different habits 
and conditions of life, but probably in part also to varying racial 
susceptibility to disease. 

The relation of social status to the rate of mortality has been often 
discussed and offers a partial explanation of racial or national varia- 
tion of death rate. That a well-to-do class, properly fed and clothed 
and with opportunity for leisure, will be less susceptible to disease 
and death than a poverty-stricken class, ill-fed and overworked, has 
been repeatedly shown by statistics. Newsholme has stated, 6 for ex- 
ample, that in Glasgow the death rate among tenants of large houses 
is much lower than among the tenants of smaller dwellings : 





One and two 
room houses. 


Three and 

four room 

houses. 


Five rooms 
and over. 


Death rate per 1,000 occupants in 1885 


27.7 


19.5 


11.2 







In Paris comparison has been made between two quarters known to 
be rich, on the one hand, and, on the other, a third quarter known to 

be poor. 

Death rate per 1,000 population. 

Rich quarters: 

Elysee 13.4 

Opera 16. 2 

Poor quarter : 

Menilinontant 31. 3 



Lemuel Shattuck, " The Vital Statistics of Boston," p. xiii. Reprinted in 
" Bills of Mortality, 1810-1849," city, of Boston, 1893. 

6 Arthur Newsholme, "Vital Statistics," London (Swan Sonnenschein), 1S99, 
p. 163. 

c E. Levasseur, " La Population Francaise," Paris, 1891, Vol. II, p. 403. 



FISHEE.] 



NATIONAL VITALITY. 



645 



In Eussia a similar comparison has been made between peasants 
who own no land, those who own less than 13J acres, those who own 
between 13J and 40J acres, and so on up the scale of proprietorship. 

Peasant death rate per 1,000, Government of Voronezh, 1889-1891. 



Class of household. 



Per 1,000. 



Having no land 

Having less than 13.5 acres 

Having 13.5 and less than 40.5 acres 
Having 40.5 and less than 67.5 acres 
Having 67.5 and less than 135 acres 
Having more than 185 acres 



34.7 
32.7 
30.1 
25.4 
23.1 
19.2 



Occupational comparisons are often made; and while they must be 
handled with great care, especially because of differences in age, the 
following may be said to display roughly the variations in death 
rate among social classes. 

Death rate of males per 1,000, according to occupations, for registration States, 

1900* 

Mercantile and trading 12. 1 

Clerical and official 13. 5 

Professional 15. 3 

Laboring and servant 20.2 

Special industries have high death rates from special diseases. 
Among dusty trades, for instance, tuberculosis is very common. 

Finally, the experience of industrial life-insurance companies, 
which deal largely with the poorer classes of society, shows a higher 
death rate than that displayed by the experience tables of other in- 
surance companies. 5 

Insurance mortality per 1,000. 



Ag« 



20 

25, 
35, 

55 
70, 



Ordinary 

insurance, 

English 

experience. 




Industrial 
insurance, 
Metropoli- 
tan Life. 



10.5 
14.1 
17.2 
35.2 
91.0 



We find also great variations in death rates dependent on. varying 
climatic or seasonal conditions, on the prevalence or absence of certain 
pests, on the fluctuating virulence of specific diseases, and on numer- 
ous natural differences. Other significant factors in mortality are 
historical events, such as wars, plagues, and epidemics. Hard times 
bring increased mortality, whether due to natural or politico-economic 
causes. There remain to be mentioned also deaths by accident in all 
its many forms. 

I. M. Rubinow, " Poverty's Death Rate," publications of the American Sta- 
.tistical Association, December, 1905, p. 348. 

6 " Twelfth Census of the United States/' Vol. Ill, p. cclxi. 

c See Frederick L. Hoffman, " Mortality from Consumption in dusty trades," 
Bulletin No. 79 of the U. S. Bureau of Labor. 

d Haley Fiske, " Industrial Insurance," The Charities Review, March 1898, p. 33. 



646 EEPOET OF NATIONAL. CONSEBVATICN COMMISSION. 

Section 5 — Mortality historically. 

Not only does the death rate vary greatly from place to place and 
from one social class to another, but it changes in a most marked 
fashion from period to period in history. The records of old cities 
show that a decided decrease in mortality has been steadily going on. 
In London, for example, the rate per 1,000 has fallen from 50 in 1660- 
1679 to 15 in 1905, a decrease of 70 per cent. In the plague years, 
1593, 1625, 1636, and 1665, the death rates per 1,000 were 240, 310, 130, 
and 430.° The " black death " in 1348-9 probably swept away half 
of the population in many localities throughout Europe. 6 

Mortality in London. 



Year. 


Rate per 
1,000. 


1660-1679 


50 


1680-1728 b 


80 


1729-1780 


40 


1905 


15.1 







• Kober, loc. cit., p. 25. 

•These years include the period of pests. 



Within a quarter century London has cut her death rate in half, 
while Vienna, if we may trust the figures, has within a century re- 
duced her rate from 60 per 1,000 of population to 23. c Similarly, the 
mortality rate in Boston has been lowered from an estimated 34 per 
1,000 d in 1700 to 19 to-day. 

Mr. John K. Gore, actuary of the Prudential Insurance Company, 
shows e that the average death rates per 1,000 of population among 
typical American cities was, for the white population, as follows: 

Years. Death rate per 1,000. 

1804-1825 24. 6 

1826-1850 25. 7 

1851-1863 28. 3 

1864-1875 25. 4 

1876-1888 22.9 

1889-1901 21.0 

The record even of the last thirty years displays a fall in death 
rates that may inspire us with buoyant hope for the future. The 
mortality rate per 1,000 has fallen in Berlin from 33 in 1875 to 16 
in 1904; in Munich, from 41 in 1871 to 18 in 1906; and in Washing- 
ton, from 28 in 1875 to 19 in 1907/ 

Between 1890 and 1906 New York lowered her death rate per 1,000 
from 25.4 to 18.6, and Boston from 23.4 to 18.9. The mortality rate 
in the whole registration area of the United States fell from 19.6 
per 1,000 in 1890 to 16.1 in 1906, although the area in the last-named 
year included a larger proportion of urban population. 

° See Farr, Vital Statistics, London, 1885, p. 131. 

& See Abbot Gasquet, "The Black Death of 1348 and 1349," London (Bell), 
1893. 

"A. F. Weber, " The Growth of Cities," New York, 1899, pp. 355, 356. 

d Shattuck, loc. cit., pp. xii-xiv. ' 

e " On the Improvement in Longevity in the United States during the Nine- 
teenth Century." 

f Kober, loc cit., p. 25. 



fisher.] NATIONAL VITALITY. 647 

We have also vital records for the city of Habana, running back 
over a century. These show that while the death rate in 1802 was 
given as 54.6 per 1,000, rising in cholera years even as high as 103.4 
(1833) and in the last year of Weyler's concentration methods as 
high as 91, the rate during the eight years from 1899-1906 ranged 
from 20.4 to 33.6.° 

These records also show the remarkable and sudden fall that may 
be brought about by a change in the living conditions of a community. 
During the three " concentration " years of 1896, 1897, and 1898 
the mortality rate per 1,000 was 51.7, 78.7, and 91, respectively. In 
1899, the first complete year of American occupation, the rate 
dropped to 33.6, and since then it has ranged between 20.4 and 24.4. 
There can be no question that the improvement was almost wholly 
due to the sanitary reforms introduced by Colonel Gorgas, and the 
other United States Army surgeons under Gen. Leonard Wood. 

The record of American Army sanitarians in the Panama Canal 
Zone shows as striking results as in Cuba. The death rate in 
Panama during 1887, when the French canal companies held occu- 
pation, ran over 100 per 1,000. In 1906 the death rate was 49 per 
1,000, while in 1907 it fell to less than 34. Colonel Gorgas attributes 
the decrease in the general death rate in great part to improved sani- 
tation, though he adds that " increased wages, better food, and better 
clothing have no doubt played a considerable part in the general im- 
provement of the health." b 

Section 6. — Adult and infant mortality. ' 

Mortality varies greatly with age. The improvement in the city 
death rate of the past half century has been especially marked 
among the young. 

It is true that in countries of the same degree of civilization the 
infant death rate is remarkably constant, but this is probably ac- 
counted for by the similarity in the methods of feeding of infants. 
Certainly where there is a difference in conditions there will be 
found a difference in mortality. Thus, the comparison between the 
mortality of infants fed on cow's milk and those fed on mother's 
milk shows that the former is five to ten times that of the latter.** 

Although the infant mortality rate is probably falling, e the de 1 
crease is not accompanied by a lowering of the mortality of later 
life. There is an increased mortality beyond the age of 50 years. 
In Massachusetts the death rates by age changed during thirty years 
as follows: 

° " Report of the National Sanitary Department of the Republic of Cuba," 
Habana, 1906, p. 78. 

& Letter from Col. W. C. Gorgas, chief sanitary officer, Canal Zone. 

c See E. B. Phelps, "A Statistical Study of Infant Mortality.'* quarterly pub- 
lication of the American Statistical Association, September, 1908. Mr. Phelps 
shows the utter unreliability of most statistics of infants under 1 year of age, 
especially in the United States. 

d See Harald Westergaard, " Mortalitat und Morbilitat," Jena, 1901, p. 364. 

e Edward E. Graham, M. D., " Journal of the American Medical Association,'*' 
September 26, 1908 ; also " British Medical Journal," February 1* 1908, p. 271. 



648 REPORT OF NATIONAL CONSERVATION COMMISSION. 

Death rate m Massachusetts per 1,000 of population in each age period. 9 



Age. 


1865. 


1895. 


6-9 ;., 


9.6 
5.1 
9.1 

12.6 

11.7 

12 

17 

33 

70 
168 


6.2 


10-14 


3.2 


15-19 


5.3 


20-29 


7.1 


30-39 


9.7 


40-49 


13 


50-59 


20 


60-69 


39 


70-79 


82 


80 and upward 


185 







« " Vital Statistics of Massachusetts," 1856-1895, p. 755. 

Here, while the death rate for all age periods under 40 has mate- 
rially decreased, the later periods of life have suffered progressive 
increases in mortality rate. 

As Frederick L. Hoffman has expressed it : 

There is, of course, no question whatever that the American death rate, using 
the term in a very comprehensive sense, has substantially declined within the 
last fifty years, but it is equally evident that this decline has been at the younger 
ages, and not during the period of life which, economically, is of the greatest 
value. There is no doubt that the mortality of adult ages is still decidedly 
excessive. 

The same tendency, viewed from the standpoint of the expectation 
of life, 6 is disclosed in the study of two Massachusetts life tables, 
compiled nearly a century apart — one, Wigglesworth's life tables for 
Massachusetts and New Hampshire in 1789, though not very accurate ; 
the other, Abbott's Massachusetts life tables for 1893-1897. 

Expectation of life in Massachusetts. 



Age. 


1789. 


1897. 


Age. 


1789. 


1897. 





35.5 

43.2 
34.2 
26 


45.4 

50 

42 

28.2 


60 


15.4 
5.9 

3.7 


15.1 


10 ; 


80 


6.1 


20 


90 


3.4 


40 











.These figures indicate that the expectation of life at the earlier 
ages is much greater than a century ago, but that for the age of 60 
and upward it has remained practically stationary. 

°At first sight it would seem that this increased mortality in later ages could 
be explained away as due to the larger number of persons who are saved from 
earlier death and tend to produce a higher mortality at the older ages. I speak 
of this because very intelligent persons have drawn this conclusion. But it is 
obviously fallacious, since the figures do not indicate the number of deaths in 
different periods, but the death rates in different periods of life per 1,000 at each 
period. There are, to be sure, as a consequence of saving lives in the past, 
more old men now living than otherwise there would be, and there will be more 
deaths, but the figures show that these old deaths have increased faster than 
the number of old men. This fact raises the suspicion, therefore, that the 
lives which have been saved by the hygiene of a generation ago are weak lives.. 
Whether this is a tenable hypothesis or not will be discussed in Chapter X. 

6 " Expectation of life " at any given age is the mean after-lifetime of per- 
sons who reach that age. Thus 100 persons have an expectation of life of 50 
at the age of 10, if the total life to be lived by those 100 persons before death 
is five thousand years. 



FISHER ] 



NATIONAL VITALITY. 



649 



English life tables ° for three decades ending 1900 display the same 
tendency. 

English life tables — Expectation of life. 



MALES. 



Age. 


1871-1880. 


1881-1890. 


1891-1900. 





41.4 

39.4 
13.1 

4.8 


43.7 

40.3 

12.9 

4.5 


44.1 


20 


41 


60 


12.9 


80 


4.6 






FEMALES. 





44.6 

41.7 

14.2 

5.2 


47.2 

42.4 

14.1 

5 


47.8 


20 


43.4 


60 


14.1 


80 


5.1 







These tables show that there is improvement at the younger ages 
for the period 1891-1900 over the period 1871-1880. For ages over 
60 there has been a retrogression. It is observable, however, that 
between the periods 1881-1890 and 1891-1900 the figures for 60 years 
have remained stationary, and for 80 have slightly improved. 

In other words, a baby to-day has in prospect a much longer 
average lifetime than did the baby of two generations ago; but a 
man or woman 60 years old has in prospect an average after lifetime 
no greater than formerly. 

The proximate cause of this contrast would seem to lie in the fact 
that the mortality from many of the diseases of later life has been 
and is on the increase. The death rates from diabetes, heart disease, 
and Bright's disease have all doubled in thirty years. 6 

Cancer is probably on the increase, and " to-day one in every 21 
men who have reached the age of 35 and one in every 12 women who 
have reached 35 eventually die of that disease." d 

In addition, there may be mentioned other diseases, arteriosclerosis, 
nephritis, apoplexy, paresis, disorders of the liver, and all manner of 
degeneration, all of them maladies of adult life, and all of them 
apparently tending to increase. 

Section 7. — Particular diseases. 

We turn now to the ravages made by particular diseases in the 
modern world. The death rate in the United States from tuber- 
culosis of all forms equals the combined death rate from small- 
pox, typhoid fever, diphtheria, cancer, diabetes, appendicitis, and 
meningitis. 

a " Supplement to Sixty-fifth Annual Report Register-General of England and 
Wales," pt. 1, 1907, p. XLVIII-LI. 

& Norman E. Ditman, M. D., " Education and its Economic Value in the Field 
of Preventive Medicine," Columbia University Quarterly, Supplement to June, 
190S, p. 38. 

c Elie Metchnikoff, " The Nature of Man," English translation, New York 
(Putnam), 1903, pp. 213, 214; see also "United States Census mortality statis- 
tics, 1906," p. 29. 

d Ditman, loc. cit., p. 38. 



650 REPORT OF NATIONAL CONSERVATION COMMISSION. 

The death rate from tuberculosis of all kinds in the registration 
area was 183.6 per 100,000 in 1907.° The rate is high among negroes. 6 
Large as these figures are, they represent a considerable decrease 
since 1900. c Tuberculosis is a preventable disease. 

On a par with tuberculosis in the number of its victims in this 
country stands pneumonia. 

The mortality statistics of the last census show that in the registra- 
tion area of the United States pneumonia is responsible for 11 per 
cent of all deaths. Pneumonia is now known to be a communicable 
disease, the germ of which is very widely distributed; but there is 
great need for special researches into the modes of spreading this 
formidable disease. In the meantime the best protection is to " keep 
in condition." While the germ of pneumonia is the exciting cause of 
the disease, predisposing causes are acute or chronic alcoholism, ex- 
posure to cold, extreme exhaustion, and debility of any kind. 

Typhoid fever is in some places yielding to preventive measures in 
a most striking manner. The fall in the death rate from typhoid in 
the registration area from 46.3 per 100,000 of population in 1890 to 
33.9 in 1900, d and to 32.1 in 1906, e may be safely ascribed to improve- 
ments in the water and milk supplies of our cities. The surprising 
reduction of the typhoid-fever death rate in individual cities, result- 
ing from definite improvements in the water supply, gives direct con- 
firmation of this statement. 

The typhoid mortality in Munich during 1856 was 291 per 100,000 
of population. The city at that time contained numerous cesspools, 
and the water supply was largely obtained from wells and pumps. 
From 1856 to 1887 there was great activity in the filling up of cess- 
pools, the abandonment of pumps and wells, and the installation of 
modern sewers. A pure water supply was also secured, the water 
being brought from a distance. The typhoid- fever death rate fell in 
1887 to 10 per 100,000 of population — a reduction of 97 per cent.f 

In Hamburg the typhoid mortality for 1880-1892 ranged from 24 to 
88, averaging 39.7 per 100,000. In May, 1893, a filtration plant was 
opened, and the rate fell in that same year to 18. For the five years 
following it averaged only 7.2, showing a reduction of over 80 per 
cent.0 

The introduction of a water filter in the town of Lawrence, Mass., 
in 1893 was followed by a reduction in deaths caused by typhoid 
from 105 in 1892 to 22 in 1896, one-fifth the previous figure. Filter- 

° For a careful statistical study of tuberculosis see " Tuberculosis iu the 
United States," United States Census, issued for the International Congress on 
Tuberculosis, 1908. See also " Bulstrode's Report in Thirty-fifth Annual Report 
of (English) Local Government Board, 1905-6," and Arthur Newsholme, M. D., 
" Prevention of Tuberculosis," 1908. 

6 For the prevalence of tuberculosis in the negro, see F. L. Hoffman's valuable 
monograph, "The American Negro," publications of the American Economic 
Association, August, 1896. 

c This decrease is shown by the exact figures (not estimated) in the registra- 
tion area. 

d Twelfth Census of the United States, Vol. Ill, p. cxliv. 

« Mortality Statistics, U. S. Census Office, 1906, p. 30. 

f Ditman, loc. cit, p. 17. 

9 A. C. Abbott, M. D., " The Hygiene of Transmissible Diseases," Philadelphia, 
Saunders, 1899, pp. 88-89. 



fisher.] NATIONAL VITALITY. 651 

ing the city water in several other American cities has shown abrupt 
declines in the typhoid death rate almost as remarkable. 

Another method of pointing out the importance of a pure water 
supply is to compare the mortality rates from typhoid fever of cities 
that secure water from various sources of supply, as the following 
table shows : 6 

Death rate from typhoid fever per 100,000 of population, 1902-1906. 

4 cities using ground water from large wells 18. 1 

18 cities using impounded and conserved rivers or streams 18. 5 

8 cities using water from small lakes 19. 3 

1 cities using water from Great Lakes 32.8 

5 cities using surface and underground water 45.7 

19 cities using polluted river water 61.1 

Thus far our studies indicate that typhoid fever will cease to be a " prob- 
lem " in any community having clean water and an uninfected milk supply, and 
in which cases of the disease are treated as dangerous and contagious." c 

Unfortunately such communities are too rare at present. 

Perhaps the most common and neglected source of danger of in- 
fection from typhoid is the ordinary house fly or, as Dr. L. O. How- 
ard, chief of U. S. Bureau of Entomology, would have us call it, 
the " typhoid fly." 

Smallpox, another disease that yields readily to preventive meas- 
ures, has decreased greatly in virulence and mortality since the 
introduction of vaccination. In Prussia, for example, the death 
rate from smallpox per 100,000 population was 24.4 in the period 
from 1846-1870. In 1874 vaccination, which up to that time had 
been only intermittently utilized, was made compulsory, and the 
death rate per 100,000 fell at once to 1.5 for the years 1875-1886. d 

Other European States, however, have been more lax than Ger- 
many. In 1886 the death rate from smallpox in Switzerland was 
fifty-fourfold that of Germany; in Belgium, forty-eightfold; in 
Austria, eighty-onefold, and in Hungary, six hundred and sevenfold. 6 

Babbage f states that " it has been shown by M. Duvillard that the 
introduction of vaccination has increased the mean duration of human 
life about three years and a half." Before Jenner's utilization of 
vaccination to guard against smallpox that disease was causing one- 
tenth^ of all deaths of the human race, just as does tuberculosis 
to-day, while " nearly twice as many were permanently disfigured by 
its ravages. In England 300 per 100,000 population died annually 
from it. It is computed that during the eighteenth century 50,000,000 
people died of smallpox in Europe.'" 1 

a See Kober, loc. cit., pp. 18, 19. 

6 Kober, loc. cit., p. 15. 

e M. J. Rosenau, L. L. Lumsden, and Jos. H. Kastle, " The origin and prev- 
alence of typhoid fever in the District of Columbia," Hygienic Laboratory 
Bulletin No. 44, 1908, p. 9. 

d Ditman, loc. cit., p. 8. 

e Floyd M. Crandall, "A century of vaccination," American Medicine, De- 
cember 7, 1901. 

f Loc. cit., p. 8. 

9 Crandall, loc. cit, p. 6. 

* Ditman, loc. cit., pp. 6, 52-3. 

S. Doc. 419, 61-2 3 



652 REPORT OF NATIONAL. CONSERVATION COMMISSION. 

Boston was visited twelve times by smallpox epidemics in the cen- 
tury and a half ending 1800.° 

Yet where vaccination has been made compulsory, or where it is 
generally resorted to, smallpox has virtually disappeared. The last 
census reported but 3,500 deaths from smallpox in the United States 
in 1900. Even as long ago as 1826 Denmark was enforcing the prac- 
tice of vaccination so vigorously that not a single case had appeared 
for eleven years. 6 Habana, during the eight years prior to the Amer- 
ican intervention, reported 3,132 deaths from smallpox. In 1899, 
the year following the American entry, there were four deaths, and 
three more during the next seven years — a virtual uprooting of the 
disease. 

The present outcry against vaccination is based on a misunder- 
standing, and is one of many evidences of the imperative necessity 
of the diffusion of correct knowledge among the people on matters 
of hygiene and preventive medicine. Whether vaccination should be 
made compulsory is a fair question, but that it is efficacious is not 
open to question. The argument that because some unvaccinated 
persons escape during an epidemic all would escape is too absurd 
to deserve serious consideration. 5 

Yellow fever first appeared in serious form at Philadelphia in 
1793, when one-tenth of that city's population died of it in the space 
of six and a half weeks. Since 1793 the United States has had 500,- 
000 cases, resulting, it is estimated, in about 100,000 deaths. In 
1900 it was discovered that a species of mosquito is responsible for 
the transmission of this fever, and in consequence of this knowledge 
and its application the disease is now practically banished from this 
country.* 5 

The marked decrease in the death rate from yellow fever in Ha- 
bana since the American intervention in 1898 is shown in the fol- 
lowing table. The deaths from yellow fever numbered 4,420 in the 
eight years from 1891 to 1898, while in the eight years from 1899 
to 1906 they numbered but 465. 

Shattuck, loc. cit, p. xiv. 

6 Crandall, op. cit. 

c Report of National Sanitary Department of the Republic of Cuba, Habana, 
1906, p. 79. 

d For the most scientific statistical studies of vaccination see W. R. Mac- 
donnell, Biometrika, Vol. I, 1902, p. 375, and Vol. II, 1903, p. 135. J. Brown- 
lee, Biometrika, Vol. IV, 1905-6, p. 313. F. M. Turner, Biometrika, Vol. IV, 
p. 483. Karl Pearson, Biometrika, Vol. IV, and Philosophical Transactions of 
the Royal Society of London, Series A, Vol. 195, p. 43. Humphreys, Journal of 
the Royal Statistical Society, 1897, p. 503. For the best of antivaccination lit- 
erature see Alfred Russell Wallace, " The Vaccination Delusion," and Milnes, 
Journal Royal Statistical Society, 1897, p. 552 (Comment by G. U. Yale, p. 608). 
For both sides see Report of the Royal Commission on Vaccination, 1897. 

e Ditman, loc cit., pp. 11-12. 



FISHER.] 



NATIONAL. VITALITY. 



653 



Yellow-fever death rate in Haoana, 1810-1906. 
[Rate per 100,000 population. ] 



Before American Intervention. 


After American intervention. 


1870... 




.. 300.5 


1898.... 




. . 67. 8 


1880... 




.. 324.5 


1899.... 




.. 42.5 


1890... 




.. 153.6 


1900. . . . 




.. 124.0 


1895... 




.. 275.8 


1901.... 




.. 6.9 


1896... 




.. 639.5 


1902.... 




.. 


1897... 




428 


1903. . . . 
1904. . . . 
1905.... 
1906. . . . 








8.0 

43 



° Report of the National Sanitary Department of the Republic of Cuba, 1906, p. 79. 

These results have been due partly to the elimination of the 
contagion-carrying mosquito and partly to the general improvement 
of the city's sanitary appointments. 

A similar contrast might be drawn between the death rates from 
yellow fever at Panama during the efforts of the French to dig the 
canal and during the American work under the sanitary regulations 
of Colonel Gorgas. If the same thoroughgoing measures used in 
Habana and at Panama were employed among our own people, the 
resultant blessings would be almost equally striking. 

The impressive figures just presented, showing the fall in mortality 
from so many of the most dangerous diseases, point clearly to the 
value of preventive measures in the conflict with disease. The fall 
in tuberculosis mortality is directly due to the growing use of hospi- 
tals, which have tended to isolate a consumptives, and to a use of our 
recently acquired knowledge of the efficacy of fresh air and the out- 
door life; typhoid fever has virtually disappeared when water and 
milk supplies have been made pure, the open privy abolished, and 
flies and other carriers of the specific cause of the disease have been 
provided against ; smallpox has given way before vaccination ; yellow 
fever is fast disappearing now that the agent of transmission is 
known ; while many of the less serious diseases are losing their power, 
purely owing to preventive methods. 

Some diseases, once the scourges of humanity, have practically 
disappeared from the civilized world. 

Scurvy up to the latter half of the eighteenth century decimated 
the armies and fleets of Europe and afterwards proved a menace to 
the civilized population. During Anson's famous expedition about 
the year 1750, 600 out of 900 died, chiefly from scurvy. The use of 
lime juice and fresh vegetables has practically eradicated the disease. 6 

" Cholera was wont to visit the cities of the Atlantic coast in the 
past about every ten years, and it was a standing menace to the world 
every summer. It was not uncommon for the disease to decimate 
whole towns and cities. Since the discovery of its cause, however, it 
has been robbed of its terrors, and the children of to-day will prob- 
ably never know of it except by name." 

Malaria has been on the decrease ever since the discovery that the 
malarial organism is transported by a species of mosquito. Even the 

° See Arthur Newsholme, " The phthisic death rate," Journal of Hygiene, 
July, 1906. 

6 Ditman, loc. cit, 14-15. 



654 



KEPOKT OF NATIONAL CONSEKVATION COMMISSION. 



five years ending 1906 show a progressive decline in the death rate 
from malarial fever in the registration area. The figures are 5.4, 4.3, 
4.2, 3.9, and 3.5 deaths per 100,000 of population, for the five years in 
question. In themselves, the figures are so small as to show the virtual 
disappearance of the disease, at least from the Northern States. It 
is still very common in the Southern States. Its evil is by no means 
to be measured by the deaths it causes. It produces chronic disability 
and predisposes to other diseases. 

Finally, the furnishing of pure milk to the infant population of the 
cities is eliminating year by year the infant scourges — diarrheal dis- 
eases and related maladies. 

There are of course diseases which show no sign as yet of decreas- 
ing. The census volume, "Mortality Statistics of 1906" (p. 29) 
gives only one important disease (diabetes) as actually on the increase 
within the registration area, but several which are given as having 
" fluctuating rates," such as cancer, heart disease, and B right's disease, 
seem still to have an upward trend. 

It is known that malaria is preventable. Why, then, is it not pre- 
vented in the South? Probably for two reasons. First, the facts are 
not generally known, owing to lack of vital statistics in the Southern 
States. Second, owing largely to this ignorance no adequate effort 
has yet been made. As an example of what can be done we have the 
cleaning of Habana by Colonel Gorgas. The following table, sup- 
plied by him, shows the deaths from malaria from 1899 to 1907 : 



Year. 


Number 
of 

deaths. 


Year. 


Number 

of 
deaths. 


1899 


909 

325 

151 

77 

51 


1904 


44 


1900 


1905 


32 


1901 


1906 


26 


1902 


1907 


a 23 


1903 











° Annual Report of the Sanitary Department for the City of Habana for the year 1907. 

" The first year quoted, 1899, the malarial deaths were excessive, 
owing to the crowding into the city of the ' reconcentrados ' and the 
starvation and misery thereby involved. 

The next year, 1900, was about the normal rate. The next year, 
1901, begins to show the effect of the antimalarial work done in con- 
nection with the yellow-fever work; 1901 was the first year of mos- 
quito work in Habana. The last year, 1907, shows only 23 deaths 
from malaria. This means practically the extinction of malaria in 
Habana. The item of 23 deaths in 1907 from malaria would probably 
be covered by the malarial cases coming in from the rural districts 
and by mistakes in diagnosis." 

The preventability of accidents is beginning to be appreciated. It 
is now proposed by Mr. W. H. Tolman to establish in New York a 
museum of safety and sanitation to demonstrate this fact. Mr. 
Frederick L. Hoffman, statistician of the Prudential Insurance Com- 
pany, estimates the number of deaths among male workers alone in 
1908 as between 30,000 and 35,000. & 

° See " Report to the Conservation Commission " of L. O. Howard. " Eco- 
nomic loss to the people of the United States through insects that carry disease." 
b " Industrial accidents," Bulletin of the Bureau of Labor, 1908. 



Part II.— THE BREADTH OF LIFE VERSUS INVALIDITY. 

Chapter III. — Prevalence of serious illness. 
Section 1 — Loss of time. 

Length of life is but one indication of vitality. Everyone recog- 
nizes that the life of a valetudinarian or an invalid, however long, is 
but a narrow stream. We may therefore conceive, besides the dimen- 
sion of length, another dimension of life which may be called its 
" breadth." By the breadth of life we mean its healthiness. Just 
as length of life is limited by and opposed to mortality or death, so 
breadth of life is limited by and opposed to invalidity or illness. 

An ideally healthy life, free throughout from ailment and dis- 
ability, is rarely if ever found. But it is the aim of hygiene to ap- 
proximate such an ideal. Some persons imagine that length of life 
can be purchased only at the expense of breadth, and counsel the 
deliberate shortening of one's life for the sake of living it faster. In 
exceptional cases such a policy may be justified, but the study of 
longevity reveals the fact that, as a rule, length and breadth of life 
are not opposed, but that, on the contrary, the one can seldom be 
increased without an increase of the other. Centenarians are usually 
persons who have been exceptionally free from illness and who 
have performed a large amount of work. This work is usually 
physical labor out of doors, although the few mental workers com- 
pleting the century have also lived busy lives. 

Chevreul, the distinguished French chemist who died twenty years 
ago at the age of 103, lived a life of great activity and usefulness as 
laboratory experimenter, as industrial chemist, as university pro- 
fessor, and as a writer and lecturer. It was said of Alexander Von 
Humboldt, who was 90 at the time of his death, that he had not only 
lived twice as long as others in years, but that in work accomplished 
he had lived twice as much per day, thus enjoying four times the 
average lifetime. 

It is shortsighted to spend more vitality each day than we earn. 
Such a policy must not only prove suicidal sooner or later, but tends 
to narrow one's life in every way long before the arrival of death. 
The ordinary individual burns the candle at both ends. The result 
is an almost universal invalidism in some degree. While statistics 
are lacking, a wide observation seems to justify the conclusion that 
it is difficult to find a man or woman over 40 whose health has not 
become impaired in some manner. Few who have not studied the 
facts realize how common illness is, although we all know it is suf- 
ficiently common to make the question " How are you?" the ordinary 
form of salutation. 

8 Metchnikoff, " The Prolongation of Life," English translation, New York, 
(Putnam's) 1908, p. 145. 

655 



656 BEPOET OF NATIONAL. CONSERVATION COMMISSION. 

Serious illness is such as totally incapacitates a person from work, 
whether or not he is confined to his bed. The burden of serious ill- 
ness is felt in several distinct ways. There is the annual idleness en- 
tailed by this illness, the cost of maintaining institutions devoted to 
the care of the sick, and the cost to the individual of medicines, medi- 
cal service, and nursing. 

The amount of invalidity or illness in a community has been esti- 
mated by a number of different investigators, and in a number of dif- 
ferent ways. While the results vary somewhat, on the whole they 
harmonize fairly well. 

The most careful consideration of the various illness statistics avail- 
able was made by Farr. He finds that the rate of invalidity increases 
with age, and at the later ages increases with great rapidity. The 
material he has used has come chiefly from various friendly societies 
in Great Britain and Scotland, and especially from the East India 
Company. His final conclusion is probably nearly as valid to-day as 
then. It is that corresponding to each death in a community, there 
are a little more than two years of illness. 

Another way of expressing the same fact is that for each annual 
death, there are on the average two persons constantly sick during the 
year. Applying this estimate to the United States, 6 in which about 
1 ,500,000 persons die per annum, there are probably at all times about 
3,000,000 persons seriously ill. This means an average of thirteen 
days per annum for each inhabitant. 

Returns gathered from 79 benefit societies in Scotland, aggregating 
over 100,000 members, and based on the experience of various periods 
between 1750 and 1821, showed that the average duration of sickness 
for each member under seventy years of age was ten days per year, 2 
of which were assumed to be " bedfast " days, five as days of walking 
sickness, and three as days of permanent sickness.* 1 

Section 2 — Particular diseases. 

It has been estimated that the number of persons in the United 
States constantly suffering from tuberculosis reaches 500,000. Of this 
number probably about half are totally incapacitated, while the re- 
mainder are able to earn about half of the ordinary wages. e 

a See Farr, Vital Statistics, London, 1885, pp. 501-514. Harald Westergaard, 
Mortalitat und Morbilitat, Jena, 1901, p. 683. See also a pamphlet by Hiram J. 
Messenger, actuary of the Travelers' Insurance Company, Hartford " The Rate 
of Sickness;" Pettenkofer, quoted by Uffelman, Handbuch der Hygiene, p. 3. 
Edwin Chadwick, " The Health of Nations," ed. by B. W. Richardson, 2 vols. 
(Longmans), London, 1887, Vol. I, p. 57 ; Mayo-Smith, " Statistics and Sociology," 
New York, (Macmillan) 1895, p. 158; " Statistische Jahrbuch fur das Deutschen 
Reich, 1908," pp. 304-305. 

6 Judging from the experience of sickness insurance, there is more sickness in 
the United States than in England. See Dr. Edward Jarvis, " Political Econ- 
omy of Health," Fifth Report of Mass. Board of Health, 1874. Dr. Jarvis also 
points out that estimates of illness are based on experience of provident persons 
among whom illness is a minimum, and that the estimates of illness take no 
account of chronic ailments or " decrepitude." 

c Farr, Vital Statistics, p. 513. 

* Edwin Chadwick, "The Health of Nations," vol. 1, pp. 56-57. 

e Irving Fisher, " The Cost of Tuberculosis in the United States and Its Re- 
duction," paper read before International Congress on Tuberculosis, Washing- 
ton, 1908; see ak:o Huber, "Consumption and Civilization," Philadelphia, 1906; 
and Bardswell, " The Consumptive Workingman," London, 1906. 



FISHER.] 



NATIONAL. VITALITY. 657 



For every death from typhoid fever, there are about 8 cases of ill- 
ness, averaging seventy-five days of incapacity. But this is not the 
only loss. Professor Sedgwick has said, " Hazen's theorem asserts that 
for every death from typhoid fever avoided by the purification of a 
polluted public water supply two or three deaths are avoided from 
other causes. Working under my direction Mr. Scott MacNutt has 
recently been able to confirm this surprising theorem, and even to 
establish it as conservative. We have also gone further than Hazen 
and discovered what the other causes are from which deaths are thus 
avoided ; and, although our results are not yet all published, I may say 
that conspicuous among these are pneumonia, pulmonary tuberculosis, 
bronchitis, and infant mortality." ° 

The prevalence of the hook-worm disease in the South has been a 
matter of investigation for several years by Doctor Stiles 6 of the 
Public Health and Marine-Hospital Service. The disease is remarka- 
ble not so much for its fatality, though that is large, as for the chronic 
incapacity for work which it produces. For this reason the hook 
worm has been nicknamed the " germ of laziness." The disease ex- 
tends over the whole South, and is responsible for a large part both 
of the sickness (the so-called " laziness ") and of the poverty of the 
" white trash." 

There are no satisfactory statistics as to the extent of hook-worm 
disease ; but it has been estimated that the sufferers are incapacitated 
for labor from one-fourth to one-half of their time. Most striking is 
the fact that the disease is easily preventable through the introduction 
of sanitary measures as well as curable by the proper (drug) treat- 
ment of the present victims. It has been largely eradicated from 
Porto Rico. c Hook-worm disease weakens when it does not kill and 
is known to be a precursor of tuberculosis. 

Malaria is one of the diseases which are fatal relatively seldom, but 
which shorten life by predisposing to other causes of death, and nar- 
row life by reducing working efficiency by a large percentage. Doctor 
Howard states that each year there are probably 3,000,000 cases of 
malaria in the United States, most of which are in the South. This 
is practically all preventable.* 

£>r. Prince A. Morrow says that the number of syphilitics in the 
United States has been estimated at 2,000,000. This disease is not 
only in itself a danger, but it also causes a large number of diseases 
of the circulatory and nervous systems. 

Doctor Morrow says that the extermination of social diseases 
would probably mean the elimination of at least one-half of our insti- 
tutions for defectives. The loss of citizens to the State from the 
sterilizing influence of gonorrhea upon the productive energy of the 
family, and the blighting destructive effect of syphilis upon the off- 
spring are enormous. In the opinion of very competent judges social 

<*w. T. Sedgwick, "The Call to Public Health," Science, 1908, p. 198. 

6 Report upon the Prevalence and Geographic Distribution of Hook-worm 
Disease in the United States," Hygienic Laboratory, Bulletin No. 10, February, 
1903, Washington. 

c " Reports of Commission on the Suppression of Uncinariasis, 1904, 1905, 
1906-7, 1907-8, San Juan, P. R." This commission has been succeeded by a 
bureau, the " Anemia dispensary service." 

* See L. O. Howard, Report to Conservation Commission, " Economic loss to 
the people of the United States through insects that carry disease." 



658 REPORT OF NATIONAL CONSERVATION COMMISSION. 

disease constitutes the most powerful of all factors in the degenera- 
tion and depopulation of the world. 

Among the troops stationed in the Philippines, the venereal mor- 
bidity during the year 1904 was 297 per 1,000, largely exceeding the 
morbidity from malarial fevers and diarrhea; 22 out of every 1,000 
soldiers were constantly ineffective from venereal diseases, four times 
as many as from any other disease. 

The statistics of the Navy Department show during the same year, 
that venereal disease was chargeable with a percentage of 25.2 
of the total number of sick days in the hospital from all causes 
combined. In four years 949 men were discharged from the navy 
for disability from venereal disease. The statistics of the English 
army show that among the troops stationed in India 537 per 1,000 
were admitted to the hospital for venereal disease. Of the troops re- 
turning home to England after completing their time of service in 
India, 25 per cent were found to be infected with syphilis. 

No statistics exist for venereal disease in civil life. It may be more 
prevalent than in the army and navy service, since the inhibitory 
influence of military restraint and discipline do not exist and the 
opportunities for licentious relations are more abundant, 

Neisser, a distinguished German authority, states that " fully 75 
per cent of the adult male population contract gonorrhea and 15 per 
cent have syphilis." 

What syphilis and gonorrhea represent in the lowered working 
efficiency of our population — to say nothing of the still more impor- 
tant subject of increased mortality — is impossible to estimate; but it 
would be difficult to overemphasize the grave danger to national ef- 
ficiency from these and the other venereal diseases. And here again 
the most striking point is that the venereal diseases are preventable. 

Alcoholism and drug addiction are maladies of frightful preva- 
lence. They are so familiar as to be taken by many as a matter of 
course. 

Venereal diseases and inebriety, whether alcoholic or drug, fre- 
quently lead to insanity. Statistics are not yet able to prove con- 
clusively that insanity is increasing, though this is the opinion of the 
best judges. 

Dr. C. L. Dana, formerly president of the New York Academy of 
Medicine, believes the increase in insanity to be real as well as ap- 
parent. He says : " The annual increment of insane in Massachusetts, 
according to the Massachusetts board of lunacy, is 400 in about 10,000, 
or 4 per cent." At this ratio the annual increment for the United 
States would be approximately 5,600. " We may say that in the last 
twenty-five years the ratio of insane to sane has shown an apparent 
gradual increase from 1 to 450 to 1 to 300, and this latter seems to be 
about the ratio in those communities of North America and Europe in 
which modern conditions of civilization prevail. This average has 
varied but little in the last few years ; the slight yearly increase prob- 
ably will not change rapidly and probably not continue, for when the 
increase in the insane reaches a certain point of excess society will 
have to take notice of it and correct it." 6 There are no accurate fig- 

° For a critical examination of statistical data on insanity, see Humphreys, 
(Noel, A.), "The alleged increase of insanity," Journal of the Royal Statisti- 
cal Society, June, 1907. 

6 " Psychiatry in its Relation to Other Sciences," section on psychiatry at the 
International Congress of Arts and Sciences, St. Louis, September, 1904. 



fisher.] NATIONAL. VITALITY. 659 

ures of the number of insane. Mr. Sanborn estimates that the number 
exceeds 250,000 in the United States. 

Among defective and disabled classes are to be especially mentioned 
the feeble-minded, paralytic, crippled, blind, and deaf mutes. The 
aggregate disability of these groups is greater than is commonly 
recognized. The preventability is still less appreciated. 

With reference to the losses each year from industrial accidents: 

The statistical report of the Interstate Commerce Commission for 
the year ending June 30, 1907, shows that during that year 11,800 
persons were killed and 111,000 injured on our American railways, 
these figures including passengers, employees, and all other persons. 
A large number of the victims were railway employees, for whose 
safety Congress has passed a number of laws. The total number of 
cases of industrial accidents can not be estimated, owing to the lack 
of statistical information ; but Census Bulletin 83 gives the number of 
deaths by accident and violence in 1900 at 57,500. 

" Of 29,000,000 workers in the United States over 500,000 are yearly 
killed or crippled as a direct result of the occupations in which they 
are engaged — more than were slain and wounded throughout the 
whole Russo-Japanese war. More than one-half this tremendous sac- 
rifice of life is needless." a 

Mr. Frederick L. Hoffman estimates 6 that the number of accidents 
among men employed in the United States in 1906 was 208,000, of 
which about 5,000 were fatal. These figures are exclusive of mining, 
railway, and shipping accidents. 

John Mitchell c estimates that for every 100,000 tons of coal pro- 
duced in the United States one mine worker is killed and several 
injured. In 1907 the figures were 2,500 coal miners killed and 6,000 
seriously injured. 

In Wisconsin from October 1, 1906, to October 1, 1907, the total 
number of accidents reported which incapacitated the victim by at 
least two weeks was 13,572. The accidents to employees constituted 
53 per cent of this number.* 

Special trades have special perils for workmen. "Among diseases 
to which workmen are most often subject are the so-called ' inanition, 
scrofula, rachitis, pulmonary consumption, dropsy ; ' also rheumatic 
troubles, pleurisy, typhoid fever, gangrene, and the various skin dis- 
eases. Every epidemic, be it typhoid, smallpox, scarlet fever, dysen- 
tery, cholera, etc., draws its greatest army of victims from this class. 
For every death that occurs among the richer and higher classes 
there are many in the working class. It is the workman engaged in 
unhealthy factories first of all who fills the hospitals and their death 
chambers." e 

It is the pollution of the air breathed by workmen, whether the 
pollution come through poisons or through dust, that makes many 
trades dangerous. Among poisonous trades are the many lead-using 

a Ditman, loc. cit., 43. 

6 In an article contributed to the " New Encyclopedia of Social Reform," 1908. 

c Speech before the Governor's Conference on Conservation, White House, 
May, 1908. 

d Thirteenth biennial Report, Bureau of Labor and Industrial Statistics, Madi- 
son, Wis., 1908. 

e C. F. W. Doehring, " Factory Sanitation and Labor Protection," Bulletin 
Department of Labor No. 44, January, 1903, p. 2. 



660 



REPORT OP NATIONAL, CONSERVATION COMMISSION. 



industries, foundries, and chemical factories. Investigations of the 
dust-producing trades have been made, showing the results on the 
respiratory systems. 

Hirt's statistics show that men employed in dust-producing occu- 
pations suffer much more frequently from pneumonia and consump- 
tion than do those not exposed to dust. The relative frequency of 
these diseases per 100 workmen is as follows: 

Cases of consumption and pneumonia per 100 tvorkers in certain occupations. 



Consump- 


Pneu- 


tion. 


monia. 


28 


17.4 


25.2 


5.9 


22.6 


6.0 


20.8 


7.7 


13.3 


9.4 


11.1 


a 4. 6 



Workers in metallic dust. . . 

Workers in mineral dust 

Workers in mixed dust 

Workers in animal dust 

Workers in vegetable dust. . 
Workers in nondusty trades 



• George M. Kober, M. D., " Industrial Hygiene," Bulletin of Bureau of Labor, March, 
1908, p. 477. 

Mr. Owen R. Lovejoy, secretary of the national child-labor com- 
mittee, has condensed a table from Indiana reports ° showing the high 
injury rate suffered by children in the industries. 

Injuries to children in Indiana, 1907. 
Proportion of adults injured j 3 P|£ *' °jj° 

Proportion of children injured j?0 per 1, 000 

* U0 per 1, 000 

The injury rate for children is shown to be three to four times as 
great as for adults. 

Chapter IV. — Prevalence of minor ailments. 
Section 1. — Importance of minor ailments. 

The statistics of morbidity which we have given refer to forms 
which are relatively acute; but there are many milder forms which 
do not incapacitate the patient from work or compel him to take 
to his bed. The extent of these milder ills is not generally appre- 
ciated. They are often carefully guarded secrets. The individual 
often knows only his own physical troubles, but is unaware of the 
fact that almost every person about him has such troubles also. Once 
you penetrate beneath conventional acquaintance there will almost 
invariably be found some functional impairment of heart, liver, 
kidneys or bladder; or dyspepsia, gastritis, jaundice, gallstones, 
constipation, diarrhea; or insomnia, neurasthenia, nervousness, neu- 
ritis, neuralgia, sick headache; or tonsilitis, bronchitis, hay fever, 
catarrh, grip, colds, sore throat; or rupture, hernia, phlebitis, skin 
eruption; or rheumatism, lumbago, gout, obesity; or decayed teeth, 
baldness, deafness, eye ailment, spinal curvature, lameness, broken 
bones, dislocations, sprains, bruises, cuts, burns, or other " troubles." 



° " Eleventh Annual Report of the Department of Inspection of Indiana, 1907," 
Exhibit C, pp. 166-198. 



fisher.] NATIONAL VITALITY. 661 

These so-called " minor ailments " will undoubtedly in the next few 
years receive much more attention than now. Until recently the 
physician has been accustomed to treat only acute diseases, but as 
preventive medicine gradually replaces curative medicine the physi- 
cian will be more called upon to treat minor ailments. These are 
generally the first warnings of more serious troubles. If what seem 
to be " mere colds " were less commonly neglected, tuberculosis would 
more often be caught in its incipiency, and pneumonia and diphtheria 
would often be prevented. 

From the " common colds " also tonsilitis and abscess of the ear can and do 
come, purulent inflammations of the pneumatic and venous cavities of the face 
and skull, and meningitis and cerebral abscess — all of which destroy many 
lives annually ; or the lives may be saved by a surgical operation after a serious 
and prolonged illness. Tonsilitis, in turn, in addition to lighting up furious 
inflammations in its own immediate vicinity, can be held responsible in a cer- 
tain number of cases for serious diseases at a distance from its own site. These 
are septic arthritis (inflammation' of joints), septic peritonitis, appendicitis, 
endocarditis (valvular disease of the heart) — severe and frequently fatal dis- 
eases. Gastritis or gastroenteritis, sick headache, jaundice, lumbago, are not 
usually of serious import, but sometimes are the signs that point to an under- 
lying cause (alcoholism, overeating, chronic protein intoxication, worry — busi- 
ness or domestic — sedentary life, etc.) which will lead later to arteriosclerosis, 
chronic nephritis, toxic amblyopia (optic nerve blindness), cirrhosis of the liver, 
cerebral hemorrhage or valvular disease of the hearts 

If the first twinges of rheumatic pains were heeded, gout and the 
dreaded arthritis deformans would lose most of their terrors. We 
could then arrest a great majority of serious affections at the very 
gateway. It can hardly be doubted that even such diseases as cancer, 
whose causation is not yet understood, gain a foothold through low- 
ered vital resistance, manifesting itself at the first in minor ailments 
of some kind. 

The American neurasthenia, widespread and subtle, has its grip on 
thousands of men and women, driving them from home and offices 
annually to sanitaria or various health resorts, and so breaking down 
their average vitality as to render them much more liable to serious 
sickness and death. 

This, the most widely prevalent of all nervous disorders in this 
country, seems to be on the increase. It is very commonly found 
among persons who take no reasonable recreation — many business 
men, among others — and the loss of time and incapacitation for work 
are very great, often weeks and months at a time. 

As to the extent to which minor ailments exist, no statistics are 
available. Doctor Castle, of Cincinnati, estimates, from an experi- 
ence of many years in the medical supervision of institution em- 
ployees and general practice, that there is an average of at least three 
days' time lost annually for each person in the population because of 
such minor ailments. Similarly, Dr. J. F. Morse, of the Battle Creek 
Sanitarium, who has had a long experience in dealing with a large 
number of cases, estimates that the average " well man " loses on an 
average five days a year from work on account of headaches, tooth- 
aches, " colds," and similar minor ailments which do not come under 
the head of any of the diseases reported. 

a Letter from Dr. Chas. H. Castle. 



662 REPORT OF NATIONAL CONSERVATION COMMISSION. 

Section 2. — Preventaoility of minor ailments. 

That almost all minor ailments can be avoided is scarcely to be 
doubted. Doctor Gulick is " inclined to .believe that something like 
nine-tenths of all the minor ailments that we have, and which consti- 
tute the chief source of decreasing our daily efficiency, could be 
removed by careful attention." " With the removal of nine-tenths of 
our disabilities and the conservation and further development of our 
natural powers," he adds, " the average person can increase his effi- 
ciency 100 per cent, that is, he can be twice as effective. This does 
not refer to doing merely or mainly twice as much work, of course, 
but by making less mistakes, and by working at a higher degree of 
speed when he does work. By working under conditions so that the 
work does not need to be repeated, the whole total will be much 
greater — I think not too much to say twice as great — as under ordi- 
nary conditions." 

Minor ailments are preventable by leading a reasonably hygienic 
life and by revising the modern gospel of " hustle " — which latter 
usually means crude, imperfect, and slovenly work, whether mental 
or manual. The prevention of these diseases would " cost " nothing — 
for it costs nothing to stay well. 

If, again, we consider the experience of those who have made a 
serious attempt to avoid minor ailments, their preventability becomes 
clear. Personally, I have known of scores of cases in which the tend- 
ency to catch cold has been almost completely overcome. In one 
case a physician, who as a boy had suffered from continual colds and 
hay fever, succeeded, through the simplification and control of his 
diet, in attaining almost complete emancipation, which has lasted over 
forty years. Another physician reports that for ten years, during 
which time he has taken special means to produce complete evacua- 
tion, he has not caught a single cold. A large number of cases ob- 
served are of persons, physicians as well as laymen, who have taken 
the outdoor cure for tuberculosis or nervous prostration. These 
persons not only succeeded in combating these serious troubles, but 
in completely freeing themselves from liability to colds. Evidently, 
if the outdoor life had been adopted simply as a preventive of colds, 
it would have prevented originally, as it cured subsequently, their 
more serious disorders. 

Chapter V. — Prevalence of undue fatigue. 

Section 1. — Strength, endurance, and fatigue. 

When a person is free from all specific ailments, both serious and 
minor, he usually calls himself " well." There is, however, a vast 
difference between such a " well " man and one in ideally robust 
health. The difference is one of endurance or susceptibility to 
fatigue. Many " well " men can not run a block for a street car or 
climb more than one flight of stairs without feeling completely tired 
out, while another " well " man will run 25 miles or climb the Matter- 
horn from pure love of sport. The Swiss guides, throughout the 
summer season day after day, spend their entire time in climbing. 
A Chinese cooly will run for hours at a stretch. That the world 
regards such performances as " marvelous feats of endurance " only 



fisher.] NATIONAL VITALITY. 663 

shows how marvelously out of training the world as a whole really 
is. In mental work some persons are unable to apply themselves more 
than an hour at a time, while others, like Humboldt or Mommsen, can 
work almost continuously through fifteen hours of the day. 

As Mosso a and others have proved, muscular fatigue is a chemical 
effect, due to the circulation of " fatigue poisons " in the blood. This 
has been strikingly shown by experiments by Weishardt and others 
on dogs; when blood is transfused from an exhausted dog to a 
" frisky " one, the latter immediately wilts and becomes fatigued 
like the former, although he has not exerted himself in the least. In 
order to reduce fatigue, therefore, we should keep down fatigue 
poisons. It is not unlikely that almost all poisons produce fatigue, 
whether the poisons come from infections, from drugs, from impure 
or excessive food, from bad air, or from exertion. 

It should be noted that endurance is a quality quite distinct from 
strength. 6 Strength is measured by the utmost force a muscle can 
exert once; endurance by the number of times it can repeat an ex- 
ertion requiring a specified fraction of available strength at the start- 
Thus, if each one of two men is barely able to lift a dumb-bell weigh- 
ing 100 pounds, their strengths are equal, but if one of them can raise 
a dumb-bell weighing 50 pounds 20 times, while the other can raise it 
40 times, the latter may be said to have double the endurance of the 
former. Another mode of expressing the same thought is that endur- 
ance is measured by the slowness with which strength decreases 
through exertion. 

Section 2. — Alcohol and fatigue. 

Of all poisons in ordinary use, alcohol and tobacco are the most 
common. That alcohol increases fatigue is now commonly recognized 
by athletes. "Alcohol gives no persistent increase of muscular power. 
It is well understood by all who control large bodies of men engaged 
in physical labor that alcohol and effective work are incompatible." c 

One of the most interesting features of the cycling sport, when long 
tours were the fashion a few years ago, was the fact that the wayside 
seller of drinks found himself forced to supply chiefly " temperance 
drinks." The cyclists discovered that they could not make their " cen- 
tury runs " on alcoholic beverages. Two friends report that they 
stopped for refreshments and drank beer. Resuming their ride they 
found it hard to propel the machine, and both imagined some obstruc- 
tion had lodged in the gears. Only after having dismounted and sat- 
isfied themselves to the contrary did they come to the conclusion, 
whether rightly or wrongly, that the resistance was in their own legs 
and was due to the beer. 

Careful experiments with alcohol in relation to fatigue have been 
reported by Rivers, 5 who shows that alcohol diminishes the capacity 

a See Fatigue, English translation. New York (Putnam), 1904. 

6 See Irving Fisher : The Effect of Diet on Endurance. ( Publications of Yale 
University, Transactions of the Connecticut Academy of Arts and Sciences; 
New Haven, 1906, p. 1.) 

c The Liquor Problem, a summary. Report of subcommittee of committee of 
fifty on phvsiological aspects of the liquor problem. New York (Houaiiton- 
Mifflin), 1905. 

d W. H. R. Rivers: "Influence of Alcohol on Fatigue, etc." London (Edward 
Arnold), 1908, pp. 89-90. 



664 KEPOET OF NATIONAL CONSEKVATION COMMISSION. 

for exertion. Experiments carried on by Professor Aschaffenburg 
with four typesetters., all users of alcohol, showed that on days when 
Greek wine, containing 18 per cent of alcohol, was given the men 
there was considerable diminution of the capacity for work. On 
the alcohol days two of the men did decidedly less work, while the 
work of the remaining two was marked by great irregularity. 

The injury from alcohol is mitigated, but not excluded, through 
combination with sugar, malt, and other beneficial ingredients, as 
in beer. 

Section 3. — Tobacco and fatigue. 

As to tobacco it is a common observation that smoking interferes 
with one's " wind " in running. The poisons which probably bring 
about this result include others than nicotine. Possibly the most 
important poison is carbon monoxide, which has a great affinity for 
the iron in the blood. a When the smoker " inhales," this poison, 
probably joined with others, enters directly into the blood stream. 

In an experiment carried on by Doctor Lombard, " smoking was 
found to have a very depressing effect upon the strength of the 
voluntary muscular contractions. * * * Undoubtedly the effect 
of tobacco to lessen the voluntary power is due to its influence upon 
the central nervous system." 6 

It is the testimony of many users of tobacco that the habit of 
smoking leads to nervousness and disinclination to exertion directly 
after smoking. 

Experimentation has shown that smoking increases blood pressure. 
The greater resistance to circulation offered by the blood is pre- 
sumably due to the excitation caused by the introduction into the 
blood stream of foreign matter from the tobacco. There is reason 
to believe, though the fact has not been established, that endurance 
is lessened by high blood pressure. 

Section 4. — Diet and fatigue. 

Poisons may also enter the system through food. Many poisons 
come from diseased, contaminated, or adulterated foods ; but they may 
also be due to excess of food or wrong preparation of foods, and espe- 
cially to the decomposition of protein (the principal ingredient of 
white of egg and lean meat) in the colon. The absorption of such 
poisons causes auto-intoxication. 

It has long been known by physiologists that the putrefaction in 
the intestines is the putrefaction of protein. But only recently have 
they raised the question whether a reduction of the protein element 
of food would be feasible and whether the resulting reduction in 
putrefaction and auto-intoxication might not be advantageous. 6 
These questions are still under debate, but the trend of physiological 
opinion is increasingly in favor of protein reduction. Practically 
this means a lessening of the consumption of lean meat and eggs. 

°"The toxicity of tobacco smoke," The Lancet, CLXXV, 1908, p. 104. 

6 Warren P. Lombard, M. D., " Some of the influences which affect the power 
of voluntary muscular contraction." Journal of Physiology, Vol. XIII, 1892, 
p. 48. 

c See C. A. Herter, " Bacterial Infections of the Digestive Tract," New York 
(Macmillan), 1907. 



FiSHEa.] NATIONAL VITALITY. 665 

Evidence has accumulated, though it has not yet been put in proper 
experimental form for absolute proof, that auto-intoxication is not 
only an exceedingly common affection, but also the chief cause of 
undue fatigue. Most persons know the heavy feeling and disinclina- 
tion to exertion which generally accompany constipation, and, on 
the other hand, the relief which comes with a complete evacuation. 

Leaving auto-intoxication aside, Professor Chittenden is of the 
opinion that waste products from combustion of protein are probably 
responsible for fatigue. Whatever the explanation, Professor Chit- 
tenden found in his classical experiment" with a squad of soldiers, 
that strength and endurance were increased by a reduction of the 
protein. Thirteen soldiers were placed for six months on a diet con- 
taining a much smaller quantity of protein food than what is pre- 
scribed by ordinary dietary standards and containing only one-third 
of what is demanded by common American usage. Professor Chit- 
tenden's results are gaining recognition, but they will need to be 
further tested before any unanimity of opinion can be reached. 

Analysis of the diet of several hundred vegetarians shows that on 
the whole they are lower in protein than the average American. 
Comparative experiments on 17 vegetarians and 25 meat eaters in the 
laboratory of the University of Brussels have shown little differences 
in strength between the two classes, but a marked superiority of the 
vegetarians in point of endurance. The average superiority was 53 
per cent. The vegetarians recuperated from fatigue more quickly 
than the meat eaters. 6 To what extent, if at all, the superiority of 
the vegetarians was due to vegetarianism as such, and to what extent 
to the fact that they made a more moderate use of protein, can not 
be exactly determined, although the evidence indicates that the lower 
protein is the essential factor. The virtues and drawbacks of vege- 
tarianism as such have as yet received almost no scientific study. c 
Professor Chittenden is now engaged in such a study. 

In another experiment, comprising 49 subjects and contrasting 
those on high and low protein diets, it was found that the low pro- 
tein subjects had greater endurance.* For instance, the test of 
"deep-knee bending" showed that whereas the high-protein subjects 
could seldom exceed 400 or 500 times, the low-protein men could fre- 
quently exceed 1,000, and in one case reached 2,400. 

The writer has in his possession several hundred unpublished in- 
dividual records of men on a low and high protein diet. These, on 
the whole, seem to show a considerable superiority in endurance 
among those using the lesser amounts of protein. But while the trend 
of evidence seems at present to favor a reduction in protein, the ques- 
tion is not yet settled/ There exist many conspicuous cases of high 

° See Russell H. Chittenden, " Physiological Economy in Nutrition," New York 
(Stokes), 1904, and "The Nutrition of Man," New York (Stokes), 1907. 

& " Enquete Scientifique sur les Vegeteriens de Bruxelles," par Mile, le Dr. J. 
Ioteyko and Mile. Varia Kipiani, Bruxelles (Lemartin), 1907. For English 
abstract see " Diet and Endurance at Brussels," Science, Vol. XXVI, 1907, pp. 
561-563. 

c An exception is Caspari, " Physiologische Studien tiber Vegetarismus," 
Bonn (Hager), 1905; see also Gautier, " Diet and Dietetics," English transla- 
tion, London, 1906. 

d Irving Fisher, " Influence of flesh eating on endurance," Yale Medical Jour- 
nal, March, 1907. 

e See, for example, Prof. F. G. Benedict's paper on " The nutritive require- 
ments of the body," American Journal @f Physiology, Vol. XVI, 1906, pp. 
409-437. 



666 REPORT OF NATIONAL, CONSERVATION COMMISSION. 

protein and great endurance. A striking instance is that of the 
pedestrian Weston. 

In an experiment on nine healthy students, the writer found that 
thorough mastication seemed to cause a gradual decrease in protein. 
The significance of the experiment lay in the improvement in physi- 
cal endurance of eight of the men, which increased over 90 per cent 
in five months. The ninth man — the only one whose protein was not 
greatly reduced — failed to improve in endurance. 

Section 5. — Exertion and fatigue. 

Exertion increases combustion of oxygen, and the capacity for ex- 
ertion is intimately related to the completeness of this combustion. 

Experiments in artificially administering oxygen to athletes have 
been made in England by Hill, Flack, Pombrey, and others. 6 Fol- 
lowing these, a series of experiments in swimming recently took 
place at Huntington, L. I. The swimmers to whom oxygen had been 
administered surpassed their nonoxygenized competitors as well as 
their own previous natural records. Doctor Bising, who carried on 
the experiment, states that the effects of oxygen inhalation are useful 
for short efforts only. At most the oxygen exercises its influence 
for not more than three minutes. 

Perhaps the most important of the common influences affecting the 
capacity to resist fatigue is physical exertion. It is well known that 
a man " in training " has greater endurance than one who attempts 
exertion without previous systematic exercise or training. In general, 
it may be said that a person in the " pink of condition " is fit not 
only for physical but also for mental exertion. The great majority of 
adults are far from being " in condition," suffering either from lack 
of exercise or from too much exercise. The ordinary man errs either 
in one direction or the other. The brain worker lives too sedentary a 
life, while the manual worker, through fatigue caused by long hours, 
is in a continual state of overexertion. Could these conditions be 
remedied, endurance, as measured by capacity to withstand prolonged 
strains, might be greatly increased. 

Experiments have shown that physical endurance can be doubled 
by dietetic causes alone, or doubled by exercise alone. By both 
together it is not unlikely that it could be tripled or quadrupled. 
But when it is said that the endurance, or capacity for exertion, of 
the ordinary healthy man could be thus multiplied, it is not meant 
that the hours of his daily work, or even his daily output of work, 
could be increased in such a ratio. What it does mean is the removal 
of the fatigue limit, a freer and more buoyant life, and a visible 
increase in the quantity and quality of work per hour. 

In an ideal life fatigue would seldom be experienced. But in 
most lives, unfortunately, fatigue is a daily experience. A workman 
who gives intelligent and systematic care to the body writes that 
when after a long day's work the factory whistle blows at night he, 
unlike his fellows, feels as fresh as when he began work in the morn- 
ing. Workmen can by such self -care mitigate some of the evils of 

° Irving Fisher, " Effects of diet on endurance," loc. cit. 

6 British Medical Journal, 1908, August 22, p. 499; also August 29, p. 578, 
Journal of Physiology, 1908, XXXVII, 77-112. 



fisher.] NATIONAL VITALITY. 667 

" the long day." But they are amply justified, both in the interest 
of their own and of national efficiency, in continuing their efforts 
toward a shortening of the work day. 

Section 6. — The working day. 

The present working day is a striking example of the failure to 
conserve national vitality. In order to keep labor power unimpaired, 
the working day should be physiological — i. e., it should be such as 
would enable the average individual to completely recuperate over 
night. Otherwise, instead of a simple daily cycle, there is a pro- 
gressive deterioration. A reduction in the length of the work day 
would be a chief means of improving the vitality of workmen, as well 
as the worth of life to them. 

The fatigue of workmen is largely traceable to their long work 
day and serves to start a vicious circle. Fatigue puts the workman 
in an abnormal frame of mind. He seeks to deaden his fatigue by 
alcohol, tobacco, exciting amusements, and excesses of various kinds. 
The momentary relief which he thereby obtains is purchased at the 
expense of an increasing susceptibility to fatigue, resulting sooner 
or later in complete depletion of his vital energies and in the con- 
traction of tuberculosis or other fatal disease. The decrease in the 
length of the working day has not diminished the total output. 

An instance in which the eight-hour day superseded the nine-hour 
day with entire success is the case of the Salf ord Iron Works, of Mather 
& Piatt, at Manchester, England, which changed to the eight-hour 
day in 1893. As the firm's products were subject to keen competition 
in both home and foreign markets, it was obliged to look carefully 
after the labor cost, and its conclusion that such cost did not increase 
in consequence of the reduction in working hours was reached after 
extremely accurate comparisons by accountants, who of course took 
into consideration the saving in consumables, wear and tear, fuel, etc. 
The Bureau of Labor inquired of Messrs. Mather & Piatt if they were 
still on the eight-hour basis, and received a reply dated May, 24, 1904, 
in which they stated that— 

onr experience since the first year in which it (the eight-hour system) was tried 
has fully borne out the conclusions then arrived at, and we are fully satisfied 
that as regards the comparison between eight and nine hours per day the bal- 
ance of advantages is in favor of the shorter period. 

In 1894 the hours of labor of about 43,000 workmen in British government 
factories and workshops were reduced to forty-eight per week. Of this number, 
18,600 received a reduction of five and three-fourths hours a week, and 24,300 
had their time reduced two and one-half hours a week. With no change in 
piece rates the workmen were able to earn as much as formerly. Day workers 
received an increased hourly rate of pay to make their earnings per week of 
forty-eight hours equal to those per week of fifty-four hours. It was not found 
necessary to increase the number of day workers. 6 

In 1899 the owners of the great Zeiss optical goods factory at Jena, 
Germany, introduced the eight-hour day and then made careful rec- 
ords of the results. In 1903 it was announced that although the 
aggregate number of hours worked had decreased 15 per cent the out- 
put per hour had increased 16.2 per cent. 

a New York Labor Bulletin No. 25, June, 1905, p. 240. 

6 Board of Trade Labor Gazette, July, 1905, reported in New York Labor 
Bulletin No. 28, March, 1906. 
New York Labor Bulletin, No. 25, June, 1905, p. 240. 

S. Doc. 419, 61-2 4 



668 REPORT OF NATIONAL. CONSERVATION COMMISSION. 

At Liege it was found in a sulphuric acid establishment similar to 
a foundry a that shortening the working day from eleven hours to ten, 
from ten to nine, and so on gradually down to seven and one-half, 
resulted, in each case, in an increase of the output. 

The Solvay Process Company, of Syracuse, installed in 1892 a 
system of three eight-hour shifts in place of the two previous shifts 
of eleven and thirteen hours, respectively. It was stated by the 
assistant general manager in 1905 that the change had considerably 
lessened the wear and tear on the men, and that they could be called 
on to do their work at their highest state of efficiency, which had not 
been possible on the two-shift basis. President Hazard of the com- 
pany writes: 

In general, I can say that the results of the change from a twelve-hour shift 
to an eight-hour shift were very satisfactory and have continued to be so. 
While the immediate result was to considerably increase the cost per unit of prod- 
uct, the efficiency of the men gradually increased, so that at the end of about 
one year the first increase has been overcome and the cost per unit of product 
fell to a point even lower than had been obtained under the twelve-hour shift, 
and further the time consumed per unit of product has since been so reduced 
that we are today and for some time have been operating with a smaller 
number of hours per unit of product than we had under the twelve-hour shift. 

Further proof of the benefits of the change to the three-shift day 
is furnished by the records of the Solvay Mutual Benefit Association 
for 1891 and 1904. The days lost per man by sickness each year fell 
from seven and one-half days in 1891 to five and one-half days in 
1904. 

It is not maintained that in all cases productivity will be as great 
in eight hours as in nine. Cases to the contrary could also be cited. 
The point to be insisted upon is not that it is profitable to an em- 
ployer to make the work day shorter, for often it is not, but to show 
that it is profitable to the nation and the race. Continual fatigue is 
inimical to national vitality, and however it may affect the commer- 
cial profits of the individual it will in the end deplete the vital 
resources on which national efficiency depends. 

In the interests of this efficiency, a longer time at noon for lunch 
is usually necessary. The present economy of lunch time is short- 
sighted, tends to food bolting, indigestion, a drowsy and tired after- 
noon, and inferior work. This has been shown by actual experience. 6 

The accident bulletins of the Interstate Commerce Commission 
contain frequent records of disasters caused by the long hours of rail- 
way employees. In a recent bulletin, No. 27, two collisions are at- 
tributed to the mistakes of employees who have been on duty much 
longer than the instinct of safety should allow. Collision No. 3, c 
which killed 2 and injured 13, was due to the mistake of a station 
operator who had been on duty from 7 a. m. to 3.30 p. m. and who 
had returned to duty at 8 p. m. The collision took place at 12.30 
a. m. the next morning. 



° See L. G. Fromont, " Une Experience Industrielle de Reduction de la Journel 
de Travail," Brussels, Solvay Institute, 1906. 

6 See especially description of a French experiment cited by Hubert Higgins 
in Humaniculture, New York (Stokes), 1906. 

•Accident Bulletin No. 27, January to March, 190& 



fisher.] NATIONAL, vitality. 669 

Section 7. — Importance of preventing undue fatigue. 

The economic waste from undue fatigue is probably much greater 
than the waste from serious illness. We have seen that the average 
serious illness per capita is usually about two weeks each year. This 
is about 4 per cent of the year. Expressed differently, about 4 per 
cent of the population is constantly sick. 

On the other hand, the number that suffer partial disability 
through undue fatigue certainly constitute the great majority of the 
population. No observer can fail to conclude that this is true of the 
American working, business, and professional classes, and the latest 
word among the students of school hygiene is that it is true to a 
large extent even among children. If therefore we assume that only 
50 per cent of the population is suffering some impairment of its 
best powers through undue fatigue, we are on safe ground. The ex- 
tent to which the power of this supposed 50 per cent of the popula- 
tion is impaired must certainly exceed 10 per cent. When we consider 
that young men, supposed to be perfectly well, have the enormous 
room for improvement indicated in this chapter, and when we con- 
sider the gratifying results of experiments with a shorter work day it 
will be seen that the true impairment is probably several times 10 per 
cent. Yet if only 50 per cent of the population are suffering an im- 
pairment equal to only 10 per cent of its working powers, the result 
is equivalent to 5 per cent of the population suffering total impair- 
ment which is more than the 4 per cent impairment from serious 
illness. 

The relatively slight impairment of efficiency due to overfatigue 
leads to more serious impairment. Just as minor ailments prove to 
have an unsuspected importance when considered as gateways to 
serious illness, so the inefficiency from fatigue is vested with great 
significance as the first step toward minor ailments. Obviously if 
overfatigue could be reduced to a minimum, this reduction would 
carry with it the prevention of the major part of minor ailments, 
which in turn would lead to a great reduction in more serious illness, 
and this finally would lead to a great reduction in mortality. A 
typical succession of events is first fatigue, then colds, then tubercu- 
losis, then death. Prevention, to be effective, must begin at the 
beginning. 

But prevention is merely the first step in increasing the breadth of 
life. Life is to be broadened not only negatively by diminishing those 
disabilities which now narrow it, but also positively by increasing the 
cultivation of vitality. Here we leave the realm of medicine and 
enter the realm of physical training. The first and lowest step is 
gymnastics. This is valuable — far more so than the ordinary seden- 
tary man who neglects it realizes — but it is after all a kind of medicine 
not altogether pleasant to take and far less valuable to him who takes 
it than are athletic sports, which constitute the next highest stage. 
Beyond athletic sports in turn comes mental, moral, and spiritual 
culture, the highest product of health cultivation. It is an encour- 
aging sign of the times that the ecclesiastical view of the Middle Ages, 
which associated saintliness with sickliness, has given way to modern 
" muscular Christianity," typified in Young Men's Christian Associ- 
ations with their gymnastics and athletics. This is but one evidence 



670 REPORT OF NATIONAL CONSERVATION COMMISSION. 

of the tendency toward the " religion of healthymindedness " de- 
scribed by Professor James. Epictetus taught that no one could be 
the highest type of philosopher unless in exuberant health. Expres- 
sions of Emerson's and Walt Whitman's show how much their spirit- 
ual exaltation was bound up with health ideals. " Give me health and 
a day," said Emerson, " and I will make the pomp of emperors ridicu- 
lous." It is only when these health ideals take a deep hold that a 
nation can achieve its highest state of development. Any country 
which adopts such ideals as an integral part of its practical life 
philosophy may be expected to reach or even excel the development 
of the health-loving Greeks. 

The means of securing both the negative prevention of invalidity 
and the positive accumulation of vitality will form the subject of 
Part III. 



Part III.— METHODS OF CONSERVING LIFE. 

Chapter VI. — Conservation through heredity. 
Section 1. — Heredity and environment. 

That the waste of life through preventable disease and death is 
enormous appears clearly from the facts already cited. The practical 
problem is this : If such waste is really preventable, what are the con- 
ditions necessary to make prevention an accomplished fact? There 
are two main conditions. First, a general desire for improvement; 
second, a general knowledge of how to secure that improvement. 

Once the general public recognizes the needless waste of vitality, 
it will not be content until that waste has been eliminated. To such 
an awakening the American instinct of economy is in itself a power- 
ful spur. Practical men are coming to consider it " good business " 
to take some care of their own vital resources. As this view gains 
ground, habits and fashions will adapt themselves to the change. 
The folly of the man who loses his health in the pursuit of wealth, 
and then for the rest of his days spends his wealth to win back health, 
is beginning to be appreciated. 

Human vitality depends upon two primary conditions, heredity 
and hygiene, or conditions preceding birth and conditions during life. 
In other words, vitality is partly inherited and partly acquired. 

It is well known that cultivated plants and animals have been 
greatly changed and developed by breeding. " The original apple, 
as offered by nature to mankind, was the small, sour, bitter crab of 
the forest, unpleasant, indigestible, innutritious. * * * In 1710 
Doctor Davenant, a writer on political economy, estimated that the 
average weight of dressed cattle did not exceed 370 pounds. * * * 
In 1846 McCullock stated that ' at present the average weight of 
cattle is estimated at or about 800 pounds.' " a 

Human heredity is now dependent on haphazard selection. Little 
attention is paid by those who contemplate marriage to the question 
of how much stamina will be transmitted to the next generation. The 
story was told of a famous dog fancier who, when asked why he paid 
so much attention to his dogs but delegated the care of his children to 1 
nurses, replied : " My dogs have a pedigree." Human pedigrees, no 
less than canine, rest on a physical basis ; yet genealogical records of 
human beings, while they have much to say of social position, have 
very little to say of physical capacity or intellectual ability. Those 
who, like Galton and Pearson, believe in a science of eugenics, hope 
that the day will come when pride of inheritance will include as im- 

° See Dr. Edward Jarvis, Political Economy and Health, Fifth Report, Mass. 
Board of Health, 1874. Doctor Jarvis adds that human life is as "expansible" 
as animal life. 

671 



672 KEPOKT OF NATIONAL CONSERVATION COMMISSION. 

portant, if not as the chief items, physical, mental, and moral stam- 
ina. A tendency in this direction can be discerned. When the no- 
bility commanded the reverence of all classes, quite irrespective of 
ability, commoners, however well endowed by nature, could never ob- 
tain the same respect. But to-day the English House of Commons is 
more honored and respected than the House of Lords. 

Once the importance of a physical pedigree comes to be rated at 
its true value, a man's pride in his own inheritance will show itself 
in a correlative feeling of responsibility for future generations. For 
the sake of children yet unborn, men and women will set for them- 
selves physical ideals of the highest order. 

Section 2. — Eugenics. 

The whole question of race improvement through heredity consti- 
tutes the subject-matter of the new science of eugenics. The devotees 
of this science are at present engaged in studying the laws of heredity 
in all its aspects. The Mendelian doctrine of heredity, with the 
theories of Darwin and Weissmann, are some of the topics which 
need to be studied in reference to their practical application. 

Until more results have been obtained, it would be premature to 
make great claims for the possible future usefulness of applied 
eugenics. A word may be said to prevent misunderstanding as to its 
aims. Many have supposed that the object of eugenics was to bring 
about suitable marriages by compulsion of the Government. Such a 
proposal would not only be absolutely impracticable, but would de- 
feat the very ends aimed at. Marriage, above all human choices, 
must, as a rule, be left to the individual, guided by his ideals alone. 
By the change of these ideals alone can the character of marriages 
be influenced. Sir Francis Galton, the founder of the science of 
eugenics, expects intelligent public opinion to be the chief guide in 
marriage. Just as the union of brother and sister is tabooed, and 
the marriage of even first cousins is eyed askance — whether justly or 
not does not matter — so, if the aims of eugenists are carried out, an 
obviously unhygienic marriage will be frowned upon. It was some- 
what in this way that the ancient Sparta raised its vitality to a high 
point of physical excellence. 

Galton has pointed out 6 that present restrictive rules of marriage 
selection are endured without any sense of loss of privilege or free- 
dom. For example, members of the European nobility are, in their 
marriage choice, restricted almost wholly to fellow-aristocrats; yet 
so much has this restriction become a part of their ideal and creed 
that the narrowness of the range of choice is not usually realized. 

Even granting that some marriages are studiously calculated to 
win money or title, a much stronger or more pervasive, although, 
unconscious, influence is exerted by the ideals which young men and 
women at marriageable age have formed of what their compan- 
ions for life should be. Nothing is more certain than that if from 

° In at least 20 States the marriage of first cousins Is forbidden by law. An 
excellent discussion of this subject is contained in " Consanguineous Marriages 
in the American Population," by G. B. L. Arner, Ph. D., New York (Longmans), 
1908. 

*" Sociological Papers," London (Macmillan), 1906, Vol. II, p. 12. 



fisher.] NATIONAL. VITALITY. 673 

childhood they were trained to regard vitality as the first essential in 
an ideal man or woman, this would influence their personal fancy. 
Health, beauty, and vitality are natural objects of admiration and 
love. Titles, wealth, and other extraneous attractions are not. To 
lessen the public esteem for these, and to increase the esteem for 
natural human merit, will tend to increase not only the number of 
healthy marriages, but the importance of the role played by normal 
love. If, therefore, eugenic ideals ever hold sway, love marriages will 
not only continue to exist, but will become more frequent. Love is a 
primal and natural instinct, and the more natural men and women 
are, and the more highly they esteem natural vitality, the more will 
they be guided by mutual attraction. 

If a considerable percentage of the population once shall come to 
regard vitality as an essential endowment, the effect on mating will 
be felt in two ways: First, a larger percentage of healthy persons 
will marry, leaving a larger percentage of unhealthy persons single ; 
second, healthy persons will mate with each other, and unhealthy 
persons, in so far as they marry at all, will do so among themselves. 
Of mixed matings there will be a smaller number. Both of these 
results will tend gradually toward the improvement of the race. 
That the first — the increased proportion of marriages among the 
healthy — will do so, is obvious. The second — the marriage of like 
with like in respect to health — would, it seems probable, operate to 
increase the number of progeny of healthy couples and decrease that 
of the unhealthy, especially after the first generation. 

Since athletics have come into vogue it is well known that the 
athletic ideal has led to athletic mating. The tendency of the present 
devotion to athletics must be to elevate the respect for physical 
prowess. The high esteem entertained in Japan for physical train- 
ing and for hygiene as a guarantee of the fighting power of the 
country, constitutes an object lesson, if not a warning, to Americans 
who wish their country to be the peer of the best. It would be folly, 
of course, to expect any change in ideals so complete that there would 
not be numerous exceptions to hygienic mating, but, once the bulk of 
mankind are guided by a truer principle in forming marriages, the 
effect on racial development will make itself distinctly felt within a 
generation. As President Roosevelt has said: "The preservation 
of national vigor should be a matter of patriotism." Some persons 
would even make it a matter of religion. 

Section 3. — Eugenics and law. 

It is possible, however, that governmental interference with the 
birth rate may in future be employed to a limited extent. Two ways 
have been suggested: One is for the Government to give prizes or 
bounties to couples that conform to certain specified standards in the 
same way as the French Government has encouraged the increase of 
population by offering inducements to couples of the poorer class 
who raise seven or more children. 

The second is to forbid alliances among criminals, paupers, and the 
feeble-minded, These classes fall under the tutelage of the State, 

In 1889, fathers of seven children were made exempt from payment of the 
personal property tax. This exemption was in 1890 limited to fathers who paid 
taxes of not over 10 francs each. 



674 KEPOET OF NATIONAL CONSERVATION COMMISSION. 

and thereby forfeit their right to free choice. Already Indiana, 
Connecticut, 6 Michigan, and other States in this country, have 
passed laws of this sort. 

Indiana extends the prohibition to all persons suffering from trans- 
missible disease of any sort. This prohibition is called into daily 
operation in that State. It is in the power of the Indiana state board 
of health to raise by degrees the standards of health demanded of 
those who desire license to marry, a provision that aims directly at 
the improvement of human vitality in the State. Indiana has gone 
even further and has recently provided d that confirmed criminals, 
imbeciles, idiots, and rapists, procreation by whom is deemed inad- 
visable by experts, shall be unsexed (or " sterilized ") by surgical 
operation. Under this law over 800 prisoners have been sterilized to 
date/ 

The experiments started in Indiana and other States will be inter- 
esting to watch, and promise an improvement over the conditions 
which have prevailed too often in the past. Professor Brewer, of 
Yale, tells of a case in Connecticut some years ago where a feeble- 
minded pauper woman, kept as a public ward, was admired by a 
half-witted farmer living in an adjoining town. A selectman of 
the town maintaining the woman " to get rid of her support " en- 
couraged their marriage. His short-sightedness, even from the stand- 
point of immediate money economy, to say nothing of racial economy, 
became apparent when, a few years later, she and her husband and 
three idiotic children drifted into the poorhouse of the husband's 
town. 

That laws like the ones discussed, but of gradually increasing 
severity, will become common in the future seems likely; and, as 
Professor Lankester has remarked, humanity will probably submit 
in the future to communal restriction of the right to multiply with as 
good grace as it has given up the right to rob and to rape/ 

The effect of restrictions upon free right of marriage is discussed 
by Doctor Hurty, secretary of the Indiana state board of health, as 
follows : 

It seems most essential and necessary that we have laws for the prevention 
of the production of the unfit if society is to be saved from destruction. Modern 
hygiene, under which I include in this instance all such benevolent institutions 
as insane asylums and institutions for the feeble-minded, is extending the dura- 
tion of life of the dependents and deficients, and it might be added that the 
humane and hygienic care in the prisons is extending the duration of life of the 
delinquents. In Indiana the life duration of the insane has been extended eight 
years within the last two decades. This slight extension means a very con- 
siderable burden upon the people, and if this class of deficients is unrestricted 
we can readily see what a burden time will place upon society. The production 
of the unfit must cease if charity and hygiene continue. Otherwise it seems 
certain that society will be swamped. 

a Indiana Laws of 1905, chap. 126, H. 118, sec. 3. 

& Connecticut Statutes (revision of 1902, sec. 1354), forbid the marriage of 
epileptics. 

c Michigan forbids the marriage of epileptics. 

<* Indiana Law of 1907, chap. 215, H. 364. 

e Letter from Dr. J. N. Hurty. 

f B. R. Lankester, "The Kingdom of Man," London (Constable), 1907, p. 41. 

The recent report of the Royal Commission on the Care and Control of the 
Feeble Minded recommends such restriction. 



fisher.] NATIONAL VITALITY. 675 

While institutional treatment of the insane is right and proper 
from a humanitarian point of view, by bringing an increase in the 
average insane lifetime it adds to the public burden and enlarges the 
figures of the living insane. Mr. Sanborn estimates the average 
insane life in Massachusetts at thirteen years, of which at least three 
years occur, on the average, before hospital treatment is applied. 
He adds: 

I suspect we have come nearer to statistical accuracy on this question in 
Massachusetts than has been reached in any region of equal population any- 
where. The world has been gradually coming round to the conclusions reached 
by the late Dr. Pliny Earle (of Northampton) and myself, viz, that the changes 
in the social and sanitary conditions of all civilized countries have increased 
the number (proportioned to population) of new cases of insanity, while the 
improved treatment of patients in the meantime has made the average insane 
life longer than formerly, and that in spite of the well-known increase in forms, 
like paresis and epilepsy, wbich may soon end fatally. 

Interesting records exist of two families of criminals, the so-called 
" Jukes " and the " Tribe of Ishmael." From the one man who 
founded the " Juke " family came 1,200 descendants in seventy-five 
years; out of these, 310 were professional paupers, who spent an 
aggregate of two thousand three hundred years in poorhouses, 50 
were prostitutes, 7 murderers, 60 habitual thieves, and 130 common 
criminals. 

Dugdale ° has estimated that the " Juke " family was an economic 
loss to the State, measured in terms of potential usefulness wasted, 
costs of prosecution, expenses of maintenance in jail, hospital, and 
asylums, and of private loss through thefts and robberies of $1,300,000 
in seventy-five years, or over $1,000 for each member of the family. 

Similarly, the " Tribe of Ishmael," numbering 1,692 individuals in 
six generations, has produced 121 known prostitutes and has bred 
hundreds of petty thieves, vagrants, and murderers. The history of 
the tribe is a swiftly moving picture of social degeneration and gross 
parasitism, extending from its seventeenth-century convict ancestry 
to the present-day horde of wandering and criminal descendants. 6 

Had the original criminals in the " Juke " family and the " Tribe 
of Ishmael " been sterilized under some law like that of Indiana, this 
country would not only have been spared a widely disseminated 
criminal, epileptic, and immoral strain, but would have saved hun- 
dreds of thousands of dollars paid out for criminal suits and for 
institutional care, to say nothing of the expenses still to come from 
the incapacity and criminality of future generations. 

These cases present only one side of the case. Over against them 
may be set illustrious families in which great intellectual ability and 
moral worth have been passed on through many generations. Such a 
one is the Hohenzollern family. In commenting on the frequent oc- 
currence of persons of surpassing mental and moral attainments in 
this family, Woods says : " It is particularly suggestive of what might 
be done with the human race were mankind ever so inclined." A simi- 
lar example from a different walk in life is afforded by the Darwin 
family, where for four generations in direct line (Erasmus, Charles, 

°R. L. Dugdale: "The Jukes," New York (Putnam), 1877. 

6 Oscar O. McCulloch, " The Tribe of Ishmael," a study in social degeneration, 
" Report of Fifteenth Annual Conference of Charities and Corrections, 1888," 
pp. 154-159. 

C F. A. Woods, "Mental and Moral Heredity," New York (Holt), p. 79. 



676 REPORT OF NATIONAL, CONSERVATION COMMISSION. 

George, Horace, and Francis) as well as in collateral lines (e. g., 
Francis Galton) scientific ability of the first rank has been manifest. 

President Roosevelt has pointed out that " race suicide " is a sign 
and accompaniment of coming decay. Mere numerical increase is 
not the whole solution, however; there must be improvement in 
quality also. A race that can not hold its fiber strong and true de- 
serves to suffer extinction through race suicide. The decline of our 
Puritan stock, so well pictured in the genteel but worn-out Pyncheon 
family of Hawthorne's novel, need not alarm us if we can replace it 
with a new influx from the West or from the vigorous stocks of 
Europe. 

There is one problem which concerns both the numbers and the 
quality of future generations, which hitherto has received practically 
no attention except in a partial report upon the subject in Australia. 
This problem is, What is now and will be the effect of voluntary 
childlessness upon the size and character of the birth rate and upon 
morals ? It would be useless, here, however, to do more than mention 
this as one of the gravest problems in the world to-day. Ronald M. 
Byrnes 6 shows that the fecundity of Yale graduates has steadily 
diminished from 5.7 for the graduates of 1701-1791 to 2.0 for those of 
1867-1886. This reduction is much greater than the reduction for the 
whole country, which is reported by the census to be from 5.8 in 1790 
to 4.6 in 1900. Degenerates have large families. From a study of 150 
degenerate families, Doctor Tredgold G found that the average num- 
ber of children per family was 7.3, while the normal average for the 
country at large (England) is 4. These figures do not specify the 
frequency of marriage among degenerates or the mortality. Unless 
the one is sufficiently low and the other sufficiently high, there must 
follow deterioration. General reduction of the birth rate may end in 
depopulation. It is not unlikely that this phenomenon will be the 
stimulus needed to bring about practical eugenic reforms. 

What eugenics might possibly accomplish is indicated by one 
writer in the following manner: "How rapidly the race wouid ad- 
vance if mankind should resolve : ' The next generation must be born 
with healthy bodies ; must be nurtured in healthy physical and moral 
environments; and must be filled with the ambition to again give 
birth to a still healthier, still nobler, generation.' " d 

•The Francis Galton Laboratory for National Eugenics, University of Lon- 
don, is soon to issue a " Treasury of Human Inheritance," containing pedigrees 
illustrating inheritance of various types of intellectual ability, of tuberculous 
stocks, of epilepsy, physical depravity, etc. 

6 Yale Review, November, 1908. 

c W. C. D. Whetham, " Inheritance and Sociology," the Nineteenth Century, 
January, 1909. 

d Louis R. Ehrich, " Posteritism," an address delivered at the dedication ex- 
ercises of The Century Chest, Colorado Springs, Colo., 1901. For literature on 
eugenics, the reader is referred to the following papers and the references therein 
contained : " Eugenics, Its Definition, Scope, and Aims," by Francis Galton, 
American Journal of Sociology, Vol. X, pp. 1-6, 1904. " The Scope and Im- 
portance to the State of the Science of National Eugenics," by Karl Pearson, 
Oxford University Press, England. " Social Darwinism," by D. Collin Wells, 
Papers and Proceedings of the American Sociological Society, Vol. I, University 
of Chicago Press. " The Human Harvest," by David Starr Jordan, Boston 
(American Unitarian Association), 1907. " Eugenics," by Prof. Albert G. Keller, 
Yale Review, August, 1908. "A First Study of the Statistics of Pulmonary 
Tuberculosis," by Karl Pearson, Drapers Company, Research Memoirs, London 
(Delau & Co.), 1907. 



fisher.] NATIONAL VITALITY. 677 

Chapter VII. — Conservation through public hygiene. 
Section 1. — Municipal hygiene. 

Whatever improvements in heredity may sometime be achieved, the 
benefits of their influence can be enjoyed only by future, perhaps dis- 
tantly future, generations. We of the present generation have to take 
our heredity as we find it. We can not follow the advice of the hu- 
morous philosopher to begin life by selecting our grandparents ; but, 
through hygiene, we can make the most of our inherited endowment. 
Even such a limited effort offers large — amazingly large — rewards. 

Ideal conditions for health comprise a pure and disease- free atmos- 
phere in which to live and work ; pure food and a pure water supply ; 
protection from infection and accident; and a proper adjustment of 
work, rest, and amusement. Existing conditions are not only far 
from ideal, but also far from what might easily and speedily be 
attained. 

That the saving power of hygiene is great is now universal^ recog- 
nized; that it will be greater is the hope and belief of those most 
competent to judge. " If hygiene were able to prolong life when it 
was little developed, as was the case until recently, we may well be- 
lieve that, with our greater knowledge of to-day, a much better result 
will be obtained." a 

There is every reason to believe that human beings are as amenable 
to cultivation as other animals and plants. Professor Graves, of the 
Yale Forest School, states that by protecting trees from infection 
their lives may often be prolonged a century. Domestic animals are 
equally dependent on care. Doctor McGee states that the growth of a 
colt may be stopped by giving it alcohol. 

The methods of securing improvement in health conditions may be 
roughly classified under three groups: Public hygiene, semipublic 
hygiene, and personal hygiene. The first group refers to activities 
of the government; the second refers to activities of the medical 
profession and institutions such as hospitals, sanatoria, schools, and 
factories, and to voluntary associations; the third group deals with 
the private life of the family and the individual. Each of these 
three groups covers phases of all three branches of hygiene, viz, 
the hygiene of environment, nutrition, and activity. 6 

In this chapter we have to deal with public or governmental 
hygiene. This branch has been chiefly concerned with pure air and 
pure food and with organisms producing epidemic diseases. Boards 
of health are a recent invention, and in this country they have as yet 
been only imperfectly developed. They can never become the power 
they should be until, first, public, opinion better realizes their use- 
fulness and the fact that their cost to the taxpayer is saved many 
times over by the prevention of death and disease ; second, more and 
better health legislation is enacted — national, state, and municipal; 
and, third, special training is secured for what is really a new pro- 

° Metchnikoff, Prolongation of Life, p. 144. 

ft Since this report was written there has appeared the excellent and inspiring 
41 Civics and Health," by William H. Allen, Bureau of Municipal Research, New 
York (Ginn), 1909. 



678 KEPOET OF NATIONAL CONSERVATION COMMISSION. 

fession, that of public health officer — a profession already recognized 
in England by a special diploma. 

The health officer should be supported entirely by the salary of his office aud 
should be absolutely prohibited from practicing medicine. Not only are his 
duties incompatible with practice quite as much as those of judges with the 
practice of law, but if he gives them proper attention there is no time for other 
duties. No court, police, or fire department, or other agency of government, 
can be more important to a people than this under the complex conditions 
incident to the rapid growth of both rural and urban populations. It is so 
important that this be realized that it is worthy of serious consideration as to 
whether it would not be better for all imperfectly equipped and supported 
health boards in this country to resign— so that the authorities and people 
would be brought face to face with the knowledge that they have no real pro- 
tection except in the emergency of an epidemic — than for existing conditions to 
continue. 

Laboratories, research workers, statisticians, and other facilities for the 
performance of a national board of health's duties should be furnished in pro- 
portion to the power and wealth of the Government and the vast interests it 
would protect and promote. The results of its scientific and collective investi- 
gations should be constantly utilized in promoting health in the army and navy, 
in protecting streams and soils from pollution, in the construction of interstate 
waterways, in the reclamation of swamp lands, and in other public works 
involving health problems of supreme importance to the future of this country. 

Public hygiene may be studied under three heads, corresponding to 
our governmental divisions: Municipal hygiene, state hygiene, and 
federal hygiene. 

Municipal hygiene and sanitation are placed largely in the hands of 
city boards of health, or equivalent organizations, which have power 
to issue sanitary regulations, abate nuisances, and even to punish 
infractions of their instructions by fine and imprisonment. Sanitary 
legislation is a product of advanced civilization. To-day not a city 
is without a board of health. The powders of these boards have 
grown, till to-day they are by no means inconsiderable; yet they 
must be given even greater authority, if our municipal sanitary con- 
ditions are to be what they should. Public apathy and political 
interference are such that health authorities can not enforce their 
orders. In addition to the acquirement of greater power, city health 
boards often need purification of motive and the banishment of 
political bickerings and personal jealousies. 

The simplest ordinances along the line of public hygiene are those 
against spitting, which now remain so largely unenforced. 

The smoke nuisance is another seemingly simple form of air vitia- 
tion that is receiving attention to-day. Sulphuric acid is apparently 
the most injurious factor. The corrosion of stone structures suggests 
the irritation resulting in catarrh and other respiratory mucous- 
membrane troubles. 6 

The effect of the introduction of closed sewers on the reduction of 
tuberculosis should not be overlooked. By closing sewers, impure 
gases have been confined, thereby removing an important source of 
air pollution. Some cities realize that pure air spells life and health 
to its inhabitants, and that pure air is a possibility only when atmos- 
pheric particles of soot and dirt are removed. 

Regulations governing garbage removal, notification and isolation 
of disease, and the like are as a rule enforced, and neAv regulations 
are being issued constantly. Substantial progress is shown each year 

a Letter from Dr. J. N. McCormack. 

b See Journal American Medical Association, September 7, 1907, p. S13. 



fisher.] NATIONAL VITALITY. 679 

in the purification of city water supplies, in the improvement of sew- 
age disposal, and in the bettering of drainage conditions. Streets 
are more thoroughly cleaned and the elimination of public and private 
nuisances continues without ceasing. 

Our city streets have received greater care since Colonel Waring 
organized his " white wings " brigade in New York City a dozen 
years ago, thus proving the great effectiveness of clean streets in the 
elimination of disease. The probable elimination of the horse from 
our city life, through automobiles, the betterment of our trolley sys- 
tems, and the introduction of subways (especially freight subways) 
will go far to improve our city atmosphere. The problem of city air 
will be half solved when our streets reach their proper state of clean- 
liness. The gradual elimination of the horse will tend not only to 
produce cleaner air, but also to reduce the dangers from flies. It is 
in horse manure that the common housefly ("typhoid fly") chiefly 
breeds. Doctor Howard attributes the termination of typhoid in 
certain parts of Washington to the displacement of the horse by the 
automobile. 

Only within a dozen years has the dread importance of insect car- 
riers of disease been realized. That mosquitoes carry malarial germs ; 
that flies are the propagators of typhoid, cholera, and other infectious 
diseases ; that rats breed the fleas which transmit to man the dreaded 
Asiatic plague a — all this knowledge is of recent origin. 5 

Well people are sometimes carriers and distribute typhoid, diph- 
theria, etc., a fact which complicates public-health regulations. 

The simple reporting of all contagious disease to the health au- 
thorities immediately on its appearance is often the means of prevent- 
ing an epidemic. 

Smallpox epidemics are prevented both by quarantine and vacci- 
nation. Because of the outcry against compulsory vaccination, in some 
places the responsibility for vaccination is being thrown upon the 
individual. This is true in Leicester, England, and in Minnesota. 
Doctor Bracken, secretary of the Minnesota State Board of Health, 
writes that since the quarantine has been abandoned and the indi- 
vidual has had the option of being vaccinated or not, a larger number 
has been vaccinated and smallpox has diminished. 

We are awaking to the importance of securing for ourselves, 
through our city health agencies, a pure milk supply. Great danger 
is also present in cream, butter, cheese, and ice cream. More than one 
city has inaugurated a policy of careful supervision of the milk sup- 
ply. Montclair, N. J., has a well-considered plan in operation 
whereby the bacterial count of each dairy is public to inquirers at 
the board of health. This species of publicity will some day prove a 
strong incentive to a better milk supply. Some cities have even estab- 
lished municipal stations, where during the summer season sanitary 
milk may be purchased at cost. Doctor Goler, of Rochester, has em- 
phasized the fact that " We employ physicians to cure children af- 

8 See Rupert Bine, " The prophylaxis and eradication of plague," California 
State Journal of Medicine, Vol. V, 1907, p. 304. 

6 A full treatment of the subject of insect-borne disease has been prepared 
by Dr. L. O. Howard, Chief of the Bureau of Entomology of the Department of 
Agriculture, for the National Conservation Commission. See also Charles Har- 
rington, M. D., "Practical Hygiene," Third Edition, Philadelphia (Lea), 1905, 
pp. 637-660. 



680 REPORT OF NATIONAL CONSERVATION COMMISSION. 

feeted by the diarrheal diseases from dirty milk, while we permit the 
sale of dirty milk from filthy cattle." ° 

In Rochester, through the efforts of Doctors Goler and Roby, a few 
municipal milk stations were established in 1897, where during July 
and August milk in nursing bottles could be bought at a low price. 
The reduction in the Rochester infant death rate between 1897 and 
1906 is doubtless due to many other conditions than the quality of 
milk ; but the special attention drawn to the milk supply and the con- 
sequent education of the public, which probably boiled its milk when 
it could not get it clean, would explain a considerable part of the 
reduction. 6 

The interrelation of the purity of milk supply and infant mortality 
is shown by the following excerpt from Doctor Woodward's annual 
report as health officer of the District of Columbia for the year 1907 : 

High as is the infantile mortality even now from diarrhea and inflammation 
of the bowels, it is far below the figures that formerly prevailed. 

The only explanation for the fall in the death rate from infantile diarrhea 
that I have been able to discover is the enactment on March 2, 1895, of the law 
regulating the sale of milk in this District and the establishment of dairy and 
dairy-farm inspection under the provision of that law. 

The weekly report of the Cincinnati board of health for August 
21, 1908, states: 

As far as we know, there has been but one death among the babies whose food 
supply has been obtained from the milk stations. When it is taken into con- 
sideration the large number of children we have supplied, this statement is 
certainly a fitting commentary upon the value of a bacteria-free and chemically 
pure milk. 

At the recent International Congress on Tuberculosis, one delegate 
reported an experiment in England which has not yet appeared in 
print. In Liverpool the local government board tried the experiment 
of using pasteurized milk. The amount of illness and death in that 
city from children's tuberculosis is very great, yet among 1,800 chil- 
dren who were given pasteurized milk and who were carefully 
watched every week not a single case of tuberculosis developed, 
which seems to prove conclusively that children's tuberculosis is en- 
tirely preventable by the use of pure or pasteurized milk. This is 
interesting, though at variance with former opinion regarding bovine 
tuberculosis in children. 

In this section should also be mentioned such municipal health 
agencies as public baths, bacteriological laboratories, and the dis- 
tribution and administration of specific antitoxin, vaccine, and free 
medical service. Municipal inspection of local abattoirs is also im- 
portant, inasmuch as federal inspection covers only establishments 
engaged in interstate business. 

Most important of all is the matter of preventing pollution of the 
water supply of cities, a topic that will receive fuller treatment later 
in the chapter. 

° See George W. Goler, M. D., " Municipal regulation of the milk supply," 
paper at the meeting of the American Medical Association, 1907, p. 2. For con- 
clusions based on a study of 330 milk-borne epidemics, see George M. Ko- 
ber, M. D., "Milk in relation to public health," S. Doc. No. 441, Government 
Printing Office, 1902. 

b See George W. Goler, M. D., " Origin, development, and results of municipal 
milk work in Rochester, N. Y.," Maryland Medical Journal, June, 1906. 



fisher.] • NATIONAL VITALITY. 681 

The needs of municipal as of state hygiene are not so much new 
laws as better men to enforce existing laws and an aroused public 
opinion that will result in the appropriation of funds sufficient to 
enable health authorities to perform their duties in an efficient man- 
ner. Larger appropriations will doubtless bring better men into the 
public-health service. 

Section 2. — State hygiene. 

State Irygiene is necessary to supplement municipal hygiene for 
many reasons. One is that the country often has no other sort of 
sanitation possible. Another is that the city is dependent on the 
country for its water, milk, and other supplies. Dr. W. G. Daggett, 
of New Haven, has emphasized the fact that in origin typhoid is 
largely a rural disease and must be combated by controlling rural 
privies and other sources of infection. A competent authority as- 
serts that " old country wells, so much valued by their owners, are 
a positive menace to public health. Fully 50 per cent of these are 
unfit for use." Much of the typhoid fever brought by milk is readily 
traceable to such wells. 

In the control of the liquor traffic the State and local units should 
cooperate. 6 

A state, rather than a municipal, function is the regulation of 
woman labor and child labor. The growth of public opinion on this 
point has been rapid. In order to make the working hours meet 
the physiological requirements of women, two special conditions 
should be attended to. One is her monthly period ; the other is child- 
bearing. The neglect of both is responsible not only for physical 
impairment of factory women, but also for their inability to perform 
their functions as mothers of the race. Doctor Stiles, of the Public 
Health and Marine-Hospital Service, has suggested a very sensible 
remedy to meet the first of these conditions, and one which has met 
with the approval of many factory employers. It is that each woman 
shall have the right, once every month, to walk out of the factory 
without any questions being asked, and without loss of the day's 
wages. The matter is further simplified in factories provided with a 
matron and a rest room. In respect to the second condition — that of 
childbearing — the evidence is clear and convincing. Women, on 
account of their imperfectly developed muscular system and more 
delicate physique, are unfitted for hard work; nor should they be 
obliged to work steadily in a sedentary position, especially at the sew- 
ing machine, or other occupations involving the use of the lower 
extremities. Special protection should be extended to them during 
the childbearing period. It is a matter of constant observation that 
women who have to deny themselves proper rest and care during the 
next six weeks after confinement are very liable to suffer from hemor- 
rhages and chronic uterine diseases, while miscarriages and prema- 
ture births are not infrequent results of overwork. 

a " The prevention of typhoid fever," Proceedings Connecticut Medical So- 
ciety, New Haven. 

& See " Regulation of the liquor traffic," Annals American Academy of Political 
and Social Science, November, 1908. 

c George M. Kober, M. D., " Industrial and personal hygiene," " Report of 
Committee on Social Betterment of the President's Homes Commission," Wash- 
ington, 1908, pp. 67-68. 



682 KEPOET OF NATIONAL CONSERVATION COMMISSION. 

The employment of mothers shortly before and after the time of 
childbirth is prohibited in a number of European countries. Ameri- 
can statutes, however, are almost silent on the question. Professor 
Jevons went so far as to advocate the enactment of legislation forbid- 
ding the employment of mothers till their youngest children were at 
least 3 years old. 

The beneficial effect on the mother, and especially on the child, of 
f rbidding the factory to her just before and after childbirth has 
been proved many times. The case of M. Dollfus, a large employer 
of women at Mulhausen, in Alsace, has been repeatedly cited. He 
required mothers to remain away from their work for a period of 
six weeks after childbirth, during which time he paid them full 
wages. The decrease in infantile mortality in the first year of the 
experiment was from more than 40 to less than 18 per cent. 6 

The waste of vitality from unphysiological hours of work is most 
striking in the case of children. It is hardly to be questioned that 
children need longer hours of rest and sleep than adults, and that 
their immature bodies are much closer to the fatigue limit. A little 
girl in a southern mill replied to Mrs. Van Vorst's query whether she 
were often tired, " Why, I'm always tired." Except in unusual cases 
and for limited periods, child factory labor can not be defended on 
any hygienic grounds. The period of preparation for a wholesome, 
healthy life should be left free from the cares and evil physical in- 
fluences of factory life. No child should run the risk of serious acci- 
dent, deformity, dwarfing, or mental stunting through factory labor. 
It is true that in the South child labor is often the lesser of two 
evils, the other being the life on a farm where, through soil pollu- 
tion, the child contracts hook-worm disease. Here the abolition of 
child labor should be preceded by the abolition of hook-worm disease. 6 

Closely connected with the restriction of child and woman labor 
is factory legislation in general, dealing with hours of labor, factory 
hygiene and sanitation, and dangers from industrial accident. 

The hours of labor have for a century been on a gradual decrease. 
A hundred years ago fourteen and fifteen hours were by no means un- 
common. The first public action regarding hours of labor was taken 
by President Van Buren in 1840, when he set ten hours as the limit 
of the working day in all government establishments. Thirty years 
later this was loAvered by Congress to eight hours. Since 1850 the 
fight has been waged for a shorter day, both by labor unions and 
individuals; and the statutes of nearly all States contain legislation 
limiting the working hours of women and children in all industries, 
as well as of all workers in certain industries, especially mining, rail- 
roading, and the more dangerous manufacturing industries. The 
Aldrich report of 1890 d estimated that the American working day 
averaged eleven and four-tenths hours in 1840 and ten hours in 18^>0. 
Tables based upon annual reports of the Bureau of Labor show a 
reduction of about 4 per cent from 1890 to 1903, e while it is the 

ffl John Spargo, "The Bitter Cry of the Children," New York (Macmillan), 
1906, pp. 44^L5. 

6 Spargo, loc. cit., pp. 50-51. 

c See " Report of the Surgeon-General of the Public Health and Marine- 
Hospital Service for 1907," relating to the investigations of Doctor Stiles. 

d " Report on Wholesale Prices and Wages," 1890. Vol. I, p. 178. 

«T. S. Adams and Helen L. Sumner, "Labor Problems," New York (Macmil- 
lan), 1905, pp. 516-518. 



fisher.] NATIONAL VITALITY. 683 

opinion of United States Commissioner of Labor Neill that the 
figures for 1908 would unquestionably be lower than for 1903, as the 
struggle for the shorter working day has been making steady prog- 
ress each year. 

The frightful losses of life and efficiency from preventable acci- 
dents can be prevented only by state legislation. 6 

Our employer's liability acts are very unsatisfactory, because they 
fix no scale of compensation for injuries, but necessitate expensive 
lawsuits to determine in each case the sum due. A president of an 
insurance company doing a large business in employer's liability 
insurance states that of the sums they pay employers only one-quarter 
reaches the injured employee, who is forced to spend the other three- 
fourths in litigation. In England the workman's compensation acts 
have substituted a system of specific sums for which the employer is 
liable. Not only does this result in larger indemnities reaching the 
injured, because suits are ordinarily unnecessary, but it has the fur- 
ther beneficial effect of reducing the number of accidents by inducing 
employers to instal safety devices. 

The regulation not only of the place of work, but also of the dwelling 
place, has come to demand action on the part of the State as well 
as of the community. The growth in tenement-house legislation dur- 
ing the past ten years has been most encouraging. Standards of 
sanitation for our large buildings have been raised: provision is in- 
creasingly made for good light, air, water, and for protection from 
fire ; and the " rookeries " of old are giving way to improved tene- 
ments. Yet New York City still contains 300,000 rooms without a 
window. 

Section 3. — Federal hygiene. 

The regulation of disease has increasingly become a national func- 
tion. The exclusion of immigrants with infectious diseases is only 
one instance of this; another is the work of our Public Health and 
Marine-Hospital Service, which not only regulates the spread of dis- 
ease from State to State, and regulates by quarantine the entry of 
disease from without the country, but also assists local health boards 
in their fights against epidemics and disease scourges. Epeciaily is 
this true in coastal cities. The Marine-Hospital Service assisted New 
Orleans to eliminate yellow fever and San Francisco to rid itself 
of bubonic plague. In addition, this service treats 50,000 seamen 
of the merchant marine each year, conducts a large number of hos- 
pitals and relief stations, examines pilots, life-saving crews and 
revenue-service men, and conducts a well-equipped hygienic labora- 
tory. 

Federal, state, and municipal sanitation are all concerned with the 
hygiene of transportation. To-day almost the whole American pub- 
lic* travels, and it is therefore most important that the conveyances 

a See Bulletin of the Bureau of Labor, No. 77, July, 1908, pp. 6-7 ; also, " First 
Annual Report on Changes in Rates of Wages and Hours of Labor in Massachu- 
setts," Boston, 1908, pp. 592-3. 

6 The Federal Government can of course reach interstate railways. A law 
passed during the last session provided for a safe locomotive ash pan. Previous 
laws provide for automatic couplers, air brakes, etc. 

C A. Jacobi, M. D., "The physical cost of women's work," Charities, February 
2, 1907. 

S. Doc. 419, 61-2 5 



684 EEPOKT OF NATIONAL CONSERVATION COMMISSION. 

which they occupy, whether carriage, cab, street car, or railway train, 
shall be sanitary in respect to ventilation, cleanliness, toilet facilities, 
spittoons, dust, smoke, sleeping-car accommodations, and the like. 
In smoking cars, in addition to the smoke itself, the floors are usually 
befouled with tobacco juice and other expectoration. The efficient 
remedy here as elsewhere is to be found, not simply in providing 
facilities for cleanliness, but in fostering the present public sentiment 
against spitting and other untidy habits. A physician of experience 
maintains the opinion that " foul air in railway trains and street 
cars is the cause of serious poisonings called ' colds ' and ' grip,' par- 
ticularly in those many trains where air from the smoker sweeps 
through passenger cars." 

The development of our national quarantine methods is indicated 
in the following paragraph from Surgeon-General Wyman, of the 
Public Health and Marine-Hospital Service : 

Until 1893 there was, properly speaking, no national system of quarantine. 
The colonies had their own quarantine regulations before the formation of the 
Union, and from that event to 1893 quarantine was left to the care of state 
governments and by the latter to county governments or to municipalities, as 
the case might be. There was, indeed, national legislation, but all the acts 
of Congress up to 1893 relating to quarantine specially provided that the said 
national measures were in aid of the state and local authorities. Whatever 
opinions may have been held by members of the national legislature, quarantine 
was permitted to be exercised by the States as a police function, and even in 
the present law, which gives national supremacy, it is provided that assistance 
shall be given the States or municipalities by the government authorities, the 
supremacy of the latter being asserted only when the state or local authorities 
fail or refuse to enforce the uniform national regulations. 

To-day efficient inspection at our various ports of entry and at 
disembarking stations abroad keeps out many cases of disease each 
year, while the quarantine cordon thrown around ports or municipal 
quarters affected by infectious disease is an important factor in 
stamping out such disease. 

Federal meat inspection chiefly benefits the foreigner, but the ad- 
ministration of the pure- food laws is of value to our own people. 

There are two functions of Federal Government which now are 
very imperfectly served and whioh might be made of paramount 
importance. They are the functions of research and of the dis- 
semination of information. A poultry raiser, or a cattleman, or a 
farmer can secure scientific information to guide him in his selections 
of fowl, or stock, or seed by applying to the Government at Washing- 
ton, but information on how to raise children has up to this time been 
neglected by our Government. Nothing is to-day more significant of 
future progress than the fact that the President, the President-elect, 
and many Congressmen are so strongly in favor of a greater federal 
organization of health. Through the dissemination of information 
throughout the country, through enactment and administration of 
effective regulations concerning pure food, inspection of meat, and 
exclusion of foreign diseases, through research, statistics, and through 
better standards for state and municipal health service, a great econ- 
omy of national vitality can be effected. Washington, our national 
capital, might be made by the Federal Government a model city of 

° Walter Wyman, M. D., " The quarantine system of the United States," 
The Sanitarian, November, 1897, p. 3. See also James W. Garner, " Federal 
activity in the interest of the public health," Yale Review, 1905-G, p. 181. 



tishbb.] NATIONAL VITALITY. 685 

healthfulness, as a preliminary to its becoming a model in every 
other way. 

Army hygiene in time of war is most important. The lack of such 
hygiene has shown grave consequences. In the Boer war the British 
army in South Africa lost more men from typhoid fever than from 
wounds received in battle.® 

The efficiency of Japanese hygiene manifests itself in the fact that 
General Oku's army of 75,000 during the recent Russo-Japanese war 
had but 187 typhoid fever cases in a seven months' active campaign. 

The Japanese reduced their dysentery cases from 12,052 in the 
Chinese war to 6,624 in the Russian war; their cholera cases from 
7,667 to none; and their malaria cases from 41,734 to 1,257. This was 
in spite of the fact that their army in the Russian war was three 
times the size of that employed in the Chinese war. & 

The crying need of better statistics is trenchantly expressed by Dr. 
Cressy L. Wilbur, Chief of the Division of Vital Statistics of the Cen- 
sus Bureau, whose words should be read and pondered by everyone 
who desires to see any intelligent conservation of our vital resources : 

Sound vital statistics are the indispensable basis of modern sanitation. A 
nation that does not consider it necessary, or tbat is not able, to provide ade- 
quate means for registering the births of its own children, or for officially 
recording the deaths of its citizens, can hardly be supposed to attach sufficient 
value to human life to enable sanitary measures for its conservation to be ade- 
quately carried out. 

For the continental United States in 1907 somewhat less than one-half of the 
total population (48.8 per cent) was represented in the registration area from 
which returns of deaths were received by the Bureau of the Census. For the 
remaining 51.2 per cent of the total population of the United States, estimated 
at 43,774,724 persons, either very imperfect laws were in effect, giving only 
partial registration, quite worthless for statistical purposes, or else the condi- 
tions in many States might be represented by the statement made by one of 
their health officers, that it buries its dead people with no more ceremony than 
it buries its dead dogs. 

As for the registration of births, a measure which is so supremely important 
for the knowledge of infant mortality, for the protection of infant life, and for 
securing the legal rights of children, not a single State in the Union nor a single 
city of any considerable size makes positive claim that it registers as many as 
nine births out of every ten that occur. Even the city of Washington, whose 
law for this purpose is a direct enactment of Congress, does not arise above 
this low limit of efficiency. The total number of births must be known before 
one can make a computation of infant mortality which will be comparable with 
the rates given in the vital statistics of all civilized nations except the United 
States. This ratio depends upon the comparison of deaths of infants under 1 
year of age with total births, and, as we have no exact registration of births, 
we can not present these important statistics. 

In the consideration of the effect of such an important disease as tuberculosis 
upon the people of the United States there is no means of knowing, within a 
very wide margin of error, exactly how many persons die from this cause in 
this country during any year. We have registration of deaths for about one- 
half of the population only, and the very dissimilar conditions of life and the 
large proportion of colored population in the unregistered half seriously inter- 
fere with any attempts to guess at the exact number. Estimates have varied 
from 138,000 to 200,000. The truth probably lies somewhere between them, but 
we certainly ought to have an exact record of the facts and not be obliged to 
depend upon mere guesswork in entering upon an important sanitary under- 
taking, such as the prevention of tuberculosis. 

° Ditman, ioc. cit, p. 17. 

6 L. L. Seaman, "The Real Triumph of Japan," New York (Appleton), 1906, 
pp. 106-7. 

On the question of army diet, see Blackham : British Medical Journal, 1908, 
August 8, p. 311. 



686 REPORT OF NATIONAL CONSERVATION COMMISSION. 

We are laboring, in conjunction with the American Medical Association, the 
American Public Health Association, and with the sanitary officials of as many 
States as we can interest, to extend the registration area as rapidly as possible. 
Ohio has just adopted an excellent law, which takes effect next year. Not a 
single State in the South has yet succeeded in reaching a satisfactory stand- 
ard — not one of them in fact has even passed an adequate law. We are de- 
pending upon the voluntary cooperation of the States. The Government has no 
power, it would seem, to collect the statistics or to secure the proper registration 
of births and deaths by its direct action. If all of the important interests in- 
volved could be awakened to the importance of this matter, if Congress would 
take a direct interest in the accomplishment of this work, we could secure fairly 
complete registration of deaths for the United States within the next ten years. 

Chapter VIII. — Conservation through semipublic hygiene. 
Section 1. — Medical research and instruction. 

By semipublic hygiene is meant hygiene through nongovernmental 
institutions, including institutions for medical research, the medical 
profession, hospitals, sanatoria, associations, schools, and factories. 

Medical discoveries have usually been made in the laboratories of 
medical schools, universities, and research institutions. The practical 
value of these institutions is only beginning to be appreciated. The 
benefits already received from them are great, and the benefits to come 
will be incomparably greater. One of the earliest medical labora- 
tories, the Pasteur Institute of Paris, has done splendid work during 
the past two decades in the study of harmful and beneficent bacteria. 
Of more recent origin are the British Sanitary Institute in London, 
the Rockefeller Institute for Medical Research, the Memorial Insti- 
tute for Infectious Diseases at Chicago, and the Nutrition Research 
Laboratory in Boston, under the Carnegie Institute of Washington. 
The recent achievement of Dr. Simon Flexner in finding a serum for 
the treatment of meningitis is but one example of what well-directed 
research under the auspices of such institutions can accomplish. The 
crowning achievement of science in the present century should be, 
and probably will be, the discovery of practical methods of making 
human life healthier, longer, and happier than heretofore. 

The medical schools in this country number 156. They are rapidly 
advancing, although the great majority are still ill equipped for pro- 
viding intending practitioners with the most recent and useful knowl- 
edge. The future practice of medicine depends more on the character 
and aims of the medical schools of to-day than on any other factor. 
At the dedication of the Harvard medical buildings in 1906, President 
Eliot laid down as the primary duties of that school the study qf the 
prevention of disease and the education of the public. The need of 
such a school especially devoted to prevention has been fully dis- 
cussed by Doctor Ditman. b Several universities have courses, or are 
taking steps to give courses in the fields not only of public hygiene 
and preventive medicine, but also of personal hygiene and home 
economics. 

° Letter from Dr. Cressy L. Wilbur. See also Irving Fisher, " Mortality sta- 
tistics of the United States census," publication of the American Economic 
Association, 1899 ; and R. Dudfield, " A critical examination of the methods of 
recording and publishing statistical data bearing on public health," Journal of 
the (Royal) Statistical Society, March, 1905. 

6 See N. E. Ditman, M. D., " Education and its economic value in the field of 
preventive medicine," Columbia University Pr?ss : Vol. X, supp. to No. 3, June, 
1908. 



fishee.] NATIONAL. VITALITY. 687 

One difficulty in establishing such a school is the lack of students 
who can afford the means or the time to attend. This was the ex- 
perience of the George Washington University, in Washington, when 
a course of this kind was offered. For this reason it is gratifying to 
see that an effort is being made to throw open the research laboratory 
of the Public Health and Marine -Hospital Service for the use of 
health officers detailed from their several States and municipalities. 
In England the degree of D. P. H. (diploma in public health) is given 
those who meet the high standard set there for health officers. 

During the last few years the American Medical Association has 
been seeking to study, classify, and improve the medical schools in 
the United States. A large committee, of which the writer is one 
member, has been appointed by the association to consider methods 
of securing such improvements as are deemed necessary. It includes 
in its scope the important but heretofore little appreciated field of 
medical economics. 

Section 2. — The medical profession. 

We come next to the part played by physicians, so far as relates to 
their " private practice." Their work as public health officers has 
already been mentioned, and does not concern us here. Their work 
in the home is of primary importance. It is on the physician that the 
average man relies for protection when he finds himself in the dread 
grip of disease. 

Private practice comprises two main divisions, surgery and gen- 
eral practice. The first important application of the knowledge of 
germs was to surgery. Antiseptic surgery, originated by Lord Lister, 
has resulted in the saving of untold thousands of lives and has led 
in turn to aseptic surgery, which is still more effective. Not only has 
it reduced the previous mortality from operations, but it has vastly 
increased the number and kind of operations which can be performed 
in cases which under the old regime would necessarily have proved 
fatal. 

Of one of the most recent advances the eminent surgeon Dr. W. J. 
Mayo writes : 

Second only to the germ theory has been the usefulness of the great discovery 
of Rontgen and the application of the X-ray to surgical diagnosis. It makes 
certain the diagnosis in a large number of conditions which were previously 
a matter of speculation, and enables remedial surgical measures at an early 
date, lessening mortality and morbidity. 

Another great surgical discovery is the suture of blood vessels evidenced by 
the work of Carrel. Its possibilities are astounding. The ability to transplant 
the kidney of one dog to another and have it continue its function, the amputa- 
tion of a leg and its resuture, opens up the whole question of the transplantation 
of sound for diseased organs, especially organs which are double. 

In these and other surgical work a certain amount of vivisection is 
necessary. The present outcry against vivisection is an example of a 
defective sense of proportion. While needless cruelty should be 
avoided, the suffering of animals through vivisection, including all 
cases where the practice has been abused, is as nothing compared with 
the suffering of human beings which would be caused if all vivisection 
were abolished. 



° Letter from Dr. William J. Mayo. 



688 KEPORT OP NATIONAL CONSERVATION COMMISSION. 

The progress of antisepsis has so reformed midwifery that puer- 
peral fever, a former scourge of humanity, is now extremely rare. 
In many cases the child, by being freed from gonorrheal contamina- 
tion by the mother at birth, has been saved from blindness. 

The advance of surgery is shown by the following table of mor- 
tality of the wounded in the wars of the nineteenth century. Anti- 
septic surgery was introduced at the time of the Franco-Prussian 
war in 1870-1 : 

Per cent. 

Crimean war, English troops 15. 2 

French troops in Italy, 1859-60 17.4 

German army, 1870-71 11. 1 

Spanish-American, 1898 6. 6 

Transvaal, 1900-1901 i. 5. 5 

In general practice progress is also being made. The use of violent 
drugs is fast going out of fashion. The recognition of the self -limit- 
ing character of most of the acute diseases sounded the death knell 
of the harsh drugging of the olden time. Laboratory experimenta- 
tion and careful study as to the physiologic and therapeutic effects 
of drugs have shown the necessity of subjecting everything material 
or immaterial, intended for the relief of human ailments, to the 
crucible of the most rigid scientific scrutiny. This sentiment has 
grown until in the best medical circles it is properly considered a 
reproach for a physician to use any preparation without an exact 
knowledge of its composition and a definite conception of the results 
expected from its administration. The number of medicines used by 
physicians is decreasing and will, if the predictions of experts in this 
field may be trusted, ultimately be reduced to a small fraction of the 
present pharmacopoeia. Many medicines, like quinine and mercury, 
will of course merit a continuance of use. Syphilis, malaria, hook- 
worm disease, and some other diseases are best combated by drugs. 

Serum therapy, although in its infancy as to most diseases, has 
opened up a field of great promise. For example, antidiphtheritic 
serum, the one best understood and in most common use, has reduced 
the mortality in that disease from 50 or 60 to 12 or 14 per cent. & Not 
so much medicines or serums, but hygiene, will probably be the de- 
pendence of the next generation of physicians. Possibly the term 
" medicine " will some day be almost as inappropriate in describing 
the treatment toward which physicians are tending as the term 
" leech " now is in describing the physician. The profession has 
ceased to be hostile to hygienic treatment, and is slowly but surely 
substituting it for much of the internal treatment formerly employed. 
The new treatment includes the use of air, light, water, food, rest, 
massage, mechanical vibration, electricity, exercise, and suggestion, 
under the names of aerotherapy, hydrotherapy, psychotherapy, etc. 
These remedies have the great advantage of preventing as well as 
curing disease. 

It only remains for all medical schools and the courses of lectures 
now gratuitously provided by the American Medical Association for 
all county medical societies to teach these things in such a thorough 
and practical way as will reach the whole profession and bring these 

°Elie Metchnikofe, "The Nature of Man," New York (Putnam), 1903, p. 210. 
6 Metchnikoff, " The Nature of Man," p. 212. 



I'ISHEB.] 



NATIONAL VITALITY. 689 



benefactions to the whole people. In proportion as prevention is 
more important than cure, the rapid advance in the knowledge and 
practice of preventive medicine will be of value. 

" To hygiene belongs without a doubt the place of honor in modern 
medicine. It is in the prevention of infectious diseases that the inter- 
est of the medical art is now mainly centered." a The best men are 
turning to these physiologic methods with enthusiasm. 6 They are 
learning to take into account the anxiety and other mental reactions 
of the patient as to what is said in his presence. 6 They are becoming 
more public-spirited and cooperative^ and alive to their responsibil- 
ity to set patients a good example in living hygienic lives. 6 

The trend toward prevention is indicated in various ways — by the 
fact, for instance, that some physicians are now employed by families, 
schools, firms, associations, etc., for the purpose chiefly of preventing 
rather than curing disease. Women dentists graduating from the 
University of Michigan have made a practice of attending to chil- 
dren's teeth at a stated amount per month. Employers are increas- 
ingly securing the services of competent physicians to care for the 
health and physical welfare of their employees. This is a preventive 
measure, and has been found to be a " paying proposition " to the 
employer because of the resulting enlarged efficiency of the workers. 

Their modern fight against tuberculosis has led physicians to a 
larger use of fresh air in their practice. At first many employed this 
agent merely as a " specific for tuberculosis," but its utility in all 
chronic ailments, such as neurasthenia, for instance, was next recog- 
nized. Latterly, fresh air has been discovered to be of use in pneu- 
monia and other acute diseases. It is now not unusual to find physi- 
cians advising their patients, whether ill or well, to sleep out of doors. 
There can be no question that man was originally an outdoor animal. 

The discovery of the germ origin of Asiatic cholera, tuberculosis, 
diphtheria, typhoid fever, bubonic plague, influenza, and other dis- 
eases, and of the part played by water, impure food, insects, rodents, 
and other common and almost omnipresent, but hitherto unrecognized, 
agencies as carriers of disease to man and animals, has awakened a 
world-wide interest in these subjects which, properly fostered and 
directed, opens up ever extending possibilities to the humanitarian, 
the economist, the statesman, and, still more, to the people at large. 

The consequence must be a great revolution in medicine in the im- 
mediate future. The practice of medicine is destined to become a 
much more powerful agent than ever before in the suppression and 
prevention of disease. This result will be reached when the change 
now going on permeates the rank and file of the profession. It would 
be a pity if, through undue conservatism of some of its members, the 
profession should lose some of its prestige hard won during the last 
generation. Already the ever-present quack is pressing into the invit- 
ing field. As the public demands " drugless treatment " and many 

° Metchnikoff, "The New Hygiene," Chicago (Keener), 1906, pp. 12-13. 

6 See G. Stanley Hall, "Adolescence," New York (Appleton), 1905, vol. 1, 
p. 238. 

c See A. T. Schofield, "Power of Mind," London (Churchill), 1902, 2d ed., 
p. 277. 

d See Osier, " Maryland Medical Journal," October, 1905, p. 420. 

e See Professor Osier's address to St. Mary's Hospital, London, 1907. 



690 REPORT OF NATIONAL CONSERVATION COMMISSION. 

physicians fail to see and meet that demand so far as it is rational, 
the quacks see their opportunity. As a consequence, there is fast 
developing a species of quack that not only does not use " patent 
medicines," but condemns their use by regular physicians. Men of 
this type base their appeals on " naturopathy," become " food ex- 
perts," prescribe fasting, or two meals a day or five meals a day, give 
lessons in " deep breathing," conduct outdoor sanatoria, and employ 
light and air baths, dry cupping, mechanical vibration, intestinal 
lavage, water cures, electricity, osteopathic manipulations, " divine 
healing," etc. All these methods have value under certain conditions; 
the only objection is that when applied by the uneducated they are 
utilized to poor advantage. The fault lies not in the therapeutic 
means but in those who use them. Physicians sometimes confuse the 
two, and make the mistake of opposing the means and user alike. 
They reject good means of cure because employed by " irregulars." 

The result is that the patient sometimes finds the best means of 
recuperation in the hands not of medical men, but of uneducated 
"physical trainers." The public will go and should go to those 
who will render the most effective help. In order that the medical 
profession may suppress quackery the way must be not to oppose 
the use of beneficial therapeutic agents in incompetent hands, but 
to get their use into competent hands by adopting them them- 
selves. There is a quackery that is villainous and injurious. This 
should be suppressed. But there is another quackery which is 
well intentioned and which, in spite of ignorance, manages to do 
some good. The good in it should be appropriated by the profession. 
By always promptly absorbing the best the profession will be in a 
position to cast out the worst in " irregular " systems of therapeutics. 
It may then recover the ground which it has too often lost. There 
was no reason why it should have lost hundreds of thousands of 
patients to " Christian Science," except that these patients were for 
the most part benefited, and greatly benefited, by Christian Science 
after having received no benefit, and often injury, from the profes- 
sion. "Easily physicians, without knowing it, can produce sickness 
by pessimistic prophecies, by anxious looks or words. Thus are 
diseases suggested (unconsciously) by the physician." Had the 
profession made use of mental therapeutics not only could they have 
saved themselves the enmity of these hundreds of thousands, but 
they could have nipped in the bud the crude metaphysics which 
teaches the nonexistence of disease and death and the uselessness of 
any therapeutic agent except those employed by the promulgator. 
The example of so-called " Christian Science " is only one of several 
protests, more or less misguided, against the present practice of 
medicine. 

Had all or most members of the profession conceded long ago the 
harmfulness of many, if not most, violent drugs it might have fore- 
stalled the present antidrug movement among the laity. The mis- 
guided antivaccination movement is simply the carrying to extremes 
of the antidrug movement. 

The Greeks were probably the most hygienic people that ever lived 
and they knew nothing of modern scientific medicine, not even of 
the circulation of the blood. This shows that man's primitive knowl- 

« Schofield, loc. cit, pp. 215-216. 



pishee.] NATIONAL VITALITY. 691 

edge or instincts may be sufficient to enable him to keep and develop 
health. 

The old code of medical ethics, though well-intentioned, was so 
inelastic and was so susceptible of misconstruction as often to block 
the way to progress. The magnitude a*nd far-reaching effects of this 
evil were long ago recognized by leading minds in the profession, and 
after years of agitation such a revision was unanimously agreed upon 
in 1903 as makes the modern principles of medical ethics purely 
advisory and far more liberal than formerly. All restrictions as to 
consultations were removed, medical societies were thrown open to 
reputable physicians of every school of practice requiring scientific 
training, and agencies put in operation for such organization and 
cooperation and to encourage such liberty of individual opinion as 
is demanded by the spirit of the age. Under the most active efforts 
of the medical schools, societies, and journals it will doubtless require 
years of time for this liberal spirit to reach all members of the pro- 
fession to the extent which is so desirable. But when this is done and 
when the public can be made to understand that it has been done the 
prejudice which has hampered the profession^ usefulness, which has 
made it so difficult to secure and enforce health and medical legisla- 
tion necessary for the protection of the highest interests of the people, 
and which has so fostered and given opportunity for quackery, will 
gradually become ancient history. 

A frequent lay comment on some members of the medical pro- 
fession is that to be true teachers of health they must practice what 
they preach. A physician can not succeed in controlling drug habits 
or alcoholism if he has these habits himself. He can not fight " patent 
medicines " if he uses them himself. He can not effectively fight the 
social evil if he himself practices abortion. The standards of the 
profession are high. It is the individual who is at fault. A clergy- 
man who preaches purity from the pulpit while living a double life 
is disgraced. In the same way, now that physicians are assuming 
the function of giving instruction in orthobiosis and hygiene, they 
are being called to account for their own daily lives. Self-interest 
and altruism alike will lead to needed corrections. The physician in 
these days of preventive medicine should keep himself well. The 
challenge "Physician, heal thyself" is being followed by the challenge 
" Keep thyself well." Example more than precept is a principle to 
be applied here as elsewhere. He can not induce his patients to diet 
or take exercise if he himself is addicted to the fleshpots and the easy 
chair. Many a physician to-day loses patients because he and his 
family are on the sick list, or because as a man he practices habits 
which as a physician he does not approve. 

The physicians in this country now number about 130.000. Their 
calling is in some respects the noblest in the world to-day. During 
the present generation the profession has begun to be appreciated for 
its great services to public and private health and for its self-sacrifice, 
which is unequaled in any other profession except the ministry. It 
has now before it an opportunity such as never before existed. Those 
of us who believe in its mission look forward to incalculable blessings 
to suffering humanity from greater knowledge better applied. 

° See A. Jacobi, Journal American Medical Association, September 29, 1906, 
p. 978. 



692 BEPOKT OF ETATIONAX. CONSERVATION COMMISSION. 

Section 3. — Institutional hygiene. 

The large cities have established special contagious hospitals, where 
prompt isolation of infectious cases may be enforced. The decrease 
of tuberculosis may be traced largely to hospital isolation. Leprosy 
was the first disease to be quarantined l and its virtual disappearance 
in civilized countries has been due, at least in the opinion of many 
authorities, to the strict isolation methods universally adopted. 

Of a different kind is the segregation of defective classes of the 
community. This has led to considerable conservation of their powers 
and abilities. Institutions for the deaf and blind in the United States 
contained 14,700 inmates in 1904, and spent for purposes of main- 
tenance over $3,500,Q00. C In these schools the deaf and dumb and the 
blind are taught trades and professions, their usefulness being thus 
much enlarged. 

The New York state commission on the blind recommended in 1907 
a state board for the blind to conduct an employment bureau for the 
blind of that State, to establish schools, and to put into operation 
measures for the prevention of blindness. It is pointed out that of the 
100,000 cases of blindness in the United States a great percentage is 
traceable to disease and accident of a preventable character. The 
commission estimates that of 1,000 cases in New York, 450 were 
possibly avoidable and 325 (or one- third) certainly so. 

For the checking of insanity the crying need is a study of the 
causes of the malady with a view to its prevention. For, as Doctor 
Ditman remarks, nine-tenths of the inmates of our insane asylums are 
incurable, according to our present knowledge. He adds : " What an 
argument for the prevention of the disease ! " d Much may be ex- 
pected from the Phipps fund, for the study of insanity, recently 
established at Johns Hopkins University. 

In the first place, our medical students should receive constant 
clinical instruction in mental diseases, particularly in their incipient 
stages. Almost equally important are popular lectures on the pre- 
ventable and other causes of insanity given under the auspices of 
medical schools or local boards of health. Such lectures have been 
given in New York and Boston, and, judging by the attendance, must 
prove a valuable agency in diffusing a correct knowledge of the cause 
and development of mental disease. In this education of the laity 
popular treatises on mental hygiene would prove most helpful. 
Such a book as Doctor Clouston's " Hygiene of Mind " could, with 
advantage, be placed in the hands of every young person, and might 
even be adopted as a text-book in high schools. Certainly the physi- 
ology of mind is as deserving of popular consideration as that of 
digestion, respiration, and the circulation. 

By a clearer insight into the beginnings of mental disease, gained 
through the popular lecture and a nontechnical literature, society 
will become so far enlightened that intelligent personal prophylaxis 



°See Newsholme, "Phthisic death rate," Journal of Hygiene, July, 1906. 
* See J. M. Eager, M. D., " The early history of quarantine," Yellow Fever 
Institute Bulletin No. 12, pp. 4-5. 

e Census report on " Benevolent institutions." 1904. 
d Ditman, loc. cit., p. 46. 



usher.] NATIONAL VITALITY. 693 

may be anticipated. A knowledge of danger is the surest means of 
guarding against it. " The most obvious line of attack must be in 
the direction of the four great etiological factors of insanity, heredity, 
alcohol, syphilis, and environment. Abstractly considered these four 
causes are preventable or removable." 6 

As an intermediate step between home and hospital, the sanato- 
rium offers both cure and prevention. Many tuberculosis sanatoria 
will take patients only in the incipient and early stages of the dis- 
ease. Sanatoria are used by many as places of recuperation. The 
tired business man and the nervous housewife find at the sanatorium 
the quiet they need, and a week or two of rest enables them to escape 
threatened serious ills. 

Many public institutions, in response to popular demand, are to- 
day installing methods and equipment that are essentially prevent- 
ive. More than one department store in the large cities filters its 
air in order that patrons and clerks shall not feel oppressed by vitia- 
tion of the atmosphere. An indirect result is the prevention 01 tuber- 
cular and other diseases. A leading hotel in Philadelphia has pitched 
tents on its roof, where a large colony of well people — not sick — 
sleep out of doors, and the same hotel utilizes its roof in winter for 
a skating rink. Mothers' clubs are an increasing factor in the spread 
of a knowledge of hygiene. Recently a case came to light of a new 
member of a mothers' club who was feeding her 5-months-old baby 
on sausage, tea cake, etc., and giving it drugs when she wanted to go 
out. She was greatly surprised when informed of the wrong she was 
doing. 

Growing interest in the science of home economics, already re- 
ferred to, is an indication of our increasing realization of the im- 
portance of healthful homes in the community. While the number 
of schools and colleges which offer courses in higher domestic science, 
and in what might be called " true home economics," is growing, they 
are nevertheless still comparatively few. More teachers should be 
equipped with scientific knowledge regarding modern sanitation in 
order that they may give practical courses in grammar and high 
schools, and higher instruction should include the topics of hygiene 
and sanitation. Home making may be studied in many details, such 
as the construction of healthful houses, the purification of food and 
water supplies, and the cleansing of cities, whereby the enlistment of 
both boys and girls in all lines of home and municipal hygiene can 
be secured. 

The churches are now joining in the health movement. The lead 
has been taken by the Rev. Elwood Worcester and Rev. Samuel 
McComb at the Emanuel Church in Boston. Trained physicians 
are employed for diagnosis and for general advice, but great em- 
phasis is laid on the power of suggestion and of Christian self-con- 
trol over bodily ills. The object is to get both patient and physician 
to stop " thinking sick and talking sick," as Doctor Goler has put it. 

°A book which brings the subject home with unusual force to the ordinary 
reader is an autobiographical sketch by a recovered patient, "A Mind that 
Found Itself," by Clifford W. Beers, New York (Longmans. Green), 1908. 

* Charles P. Bancroft, M. D., " Hopeful and discouraging aspects of the psy- 
chiatric outlook," address at meetiDg of American Medico-Psychological Asso- 
ciation, Cincinnati, 1908. 



694 EEPORT OF NATIONAL, CONSEKVATION COMMISSION. 

Section 4. — School hygiene. 

In every progressive country to-day the hygiene of school life is 
coming to be regarded of paramount importance. At the Inter- 
national Congress on School Hygiene, in London, August 5-10, 1907,° 
there were in attendance at least 500 delegates, representing the gov- 
ernments of the world and societies devoted to the advancement of 
human welfare, and in addition there were 1,500 individuals inter- 
ested in the improvement of the health of school children and all 
that this implies. The fact was brought out at the congress that 
European countries, notably Switzerland, Germany, France, Eng- 
land, and Scotland, are doing more than the United States in the 
medical inspection of schools and that they are seemingly making 
plans for the improvement in every direction of the hygienic con- 
ditions of school life. 6 Even in Italy the leading statesmen are ap- 
parently convinced that the matter of chief importance at the present 
moment in their educational work is to place it, from start to finish, 
upon a hygienic basis. 

It is the unanimous opinion of all students of the matter that the 
neglect of the hygiene of school life in the larger sense is, first of all, 
more or less disastrous to a considerable proportion of the pupils.^ 
With us, as well as in most European countries, children are com- 
pelled by the state to attend school for a number of years. Many 
of them suffer constantly from defective vision, hearing, and respira- 
tion, from nervous overstrain, and from other ailments which are 
greatly aggravated by the confinement and stress of school life. e 
Pupils are always exposed to infectious diseases. It is no unusual 
thing in our country to see a contagious disease sweep through a 
whole school so rapidly that the local board of health can hear of it 
and order the school closed only after the harm has been done. 

Great as is the injury done by the spread of infectious diseases to 
children thus massed together in schools, the injury resulting from 
imperfect seating, lighting, ventilation, and sanitation of school 
buildings is still more serious. In every part of our country, as 
well as in the progressive countries of Europe, those familiar with 

°The proceedings of the congress contain papers by distinguished physicians, 
and educators upon every phase of the hygiene of school life. Existing evils 
are pointed out and remedies suggested. Summaries of the papers may be 
found in the Nineteenth Century, September, 1907, pp. 388-394. 

6 In addition to papers presented at the International Congress on School 
Hygiene, see the following : A series of articles in the School Review ( Univer- 
sity of Chicago) for 1907, by Prof. Hermann Schwartz, entitled "The study of 
experimental pedagogy in Germany." Many articles in the magazine Zeit- 
schrift fur Schulgesundheitspflege show the great interest in Germany in school 
hygiene. Professor Binet, of Paris, has established a laboratory for the study 
of childhood in relation to educational work, and he will give particular at- 
tention to problems concerning physical defects and mental and moral short- 
comings. For other such institutions see The Psychological Bulletin, Vol. VI, 
March 15, 1909, pp. 84-103. 

c See, for example, Professor Garlanda's "II Terzia Italia," in which ne 
shows the only way in which Italy can regain her old-time vigor and efficiency. 

d See M. V. O'Shea: "Dynamic Factors in Education," New York (Mac- 
millan), 1906, Part II, where the whole subject is discussed. 

e See Oppenheim : " The development of the child," Chap. V. Also Tyler : 
"Growth and education;" Burbank: "The training of the human plant;" 
Burk : " From fundamental to accessory," etc. ; Pedagogical Seminary, Vol. VI. 
Krseplin: "A measure of mental capacity," Popular Science Monthly, vol. 49. 



FU3HER.] NATIONAL VITALITY. .695 

the situation are appealing most urgently for improvement in the 
physicial basis of education. This is not the place to recite the dis- 
abilities which are said by men competent to speak on the subject 
to result from keeping children for at least eight years in confinement 
and at hard mental labor under conditions that waste their vitality 
and develop bodily defects and habits prejudicial to health. The 
list of such disabilities is a long and impressive one.° Unfortunately, 
we do not, as a people, sufficiently appreciate that the character of 
social life with us is changing rapidly, and that consequently our 
children are particularly susceptible to certain diseases and defects; 
to wit, those arising from the adoption of an indoor life of compara- 
tive muscular inactivity, with greatly increased demands made upon 
particular organs, such as the eyes and the brain. 

Doctor Cronin, of New York, maintains that in a school population 
of 650,000, 30 per cent of the children were from one to two years 
behind their proper class. Ninety-five per cent of these backward 
children were so principally because of defects of eye, ear, nose, or 
throat, which could easily be detected and remedied through effective 
medical inspection. Experiments at home and abroad have proven 
beyond any doubt that the majority of children of this sort, when 
given proper medical treatment, improve markedly in intellect and 
general conduct. The State attempts to educate these children, but 
its effects are to a large extent wasted. Doctor Osier calculated 
that in the special city to which reference has been made there was, 
on account of a lack of medical supervision of educational work, a 
yearly financial loss of $1,666,666 ; and of course the loss which came 
from moral deviation due to defective physical functioning was of 
far greater importance. Doctor Osier said recently, in effect, that 
he considered it of greater importance to the nation that the question 
of sound teeth be intelligently considered than that the consumption 
of alcohol be restricted, important as the latter problem is. In similar 
vein, Doctor Newton reports a case of an old, unhygienic school build- 
ing in a small town being fitted up with a ventilating system, with 
the result that the cost of the improvement was saved in a short time 
in salaries that otherwise would have been paid to extra teachers for 
taking the place of those made sick by the foul air in the building. 

We now know the major effects at least on intellect and tempera- 
ment of sense defects, adenoids, decaying teeth, and minor physical 
deformities; and we also know how such deviation from normality 
can be readily and inexpensively detected and remedied, 6 but there 
are whole States where no advantage whatsoever is taken of this 
knowledge, and in practically qyqtj State in the country there are 
communities in which absoluteh 7 no attention is paid to any of these 
matters. The people go on in traditional ways, trusting to luck and 
disregarding the changes taking place in society. 

a See Shaw: "School hygiene;" Keating: "Mother and child;" Ballantyne. 
in the Lancet, Vol. 2, 1890 ; Bancroft : " Physical Education Review," Vol. VII ; 
Rowe, " The lighting of schoolrooms ; " Burrage and Bailey : " The Sanita- 
tion and decoration of school buildings." The Magazine of School Hygiene, 
published under the direction of the School Hygiene Association, contains in 
each issue articles showing the evils resulting from unhygienic conditions in the 
schools. 

6 See, for example, two books by Doctor Warner, of London : " The Study of 
Children " and " The Nervous System of the .Child." The city of Chicago main- 
tains a department for the study of backward and defective children in the 
public schools. 



696 



EEPORT OF NATIONAL CONSERVATION COMMISSION. 



The health of our school children, then, should be conserved by a 
system of competent medical inspection ° which should secure the 
correction of defects of eyes, ears, teeth, as well as defects due to 
infection or malnutrition. In Europe — 

all the investigations disclosed an astonishing amount of ill health among 
school children ; and though the variations from the normal were found to 
differ in degree, they were on every hand alike in kind. In nearly every 
instance they were more pronounced in girls than in boys, and were often most 
manifest in scholars of the better social classes. Thus there were discovered 
the following percentages of morbidity among school boys: In Great Britain, 
20; in Denmark, 29; in Germany, 30; in Copenhagen, 31; and in Sweden, 37. 
The percentages noted among the girls were: In Great Britain, 16; in Copen- 
hagen, 39; in Denmark, 41; in Lausanne, 43; in Germany, 50; and in 
Stockholm, 62 — an average morbidity for boys of 29 and for girls of 42 per 
cent. 6 

Similar results have been reached in certain cities of the United 
States. A " committee on the physical welfare of school children " 
in New York City examined New York school children and found 
that c — 

66 per cent needed medical or surgical attention or better nourish- 
ment. 

40 per cent needed dental care. 5 

38 per cent had enlarged glands of the neck. 

31 per cent had defective vision. 

18 per cent had enlarged tonsils. 

10 per cent had postnasal growths. 

6 per cent were undernourished. 

Dr. Walter Cornell has been making an extensive study of eye 
strain among school children. These were his findings : • 

The relationship of poor vision to scholarship was studied in 219 children. 
As will be noticed, the difference in marks between those with normal and those 
with bad vision is greatest in arithmetic and spelling, which studies require 
more extensive use of the blackboard. 

Scholarship percentages obtained. 



Children with- 



Nonnal dsion 

Fair vision 

Bad vision 



Arith- 
metic. 



79 

70 

66 



Geogra- 
phy. 



69 

71 
70 



Spelling. 



76 
77 
71 



Average. 



75- 
73+ 
69 



In New York City 29.5 per cent of 79,069 children examined suffered from 
defective vision. In London 26 per cent of 20,000 children examined by eight 



° See Gulick and Ayres. " Medical Inspection of Schools," Russell Sage 
Foundation Publication, New York, 1908; see also "The Psychological Clinic," 
especially Vol. ii, No. 8. 

& G. Woodruff Johnson, M. D., " Effects of school life on children's health," 
North American Review, vol. 1S2, p. 831. 

c Ditman, loc. cit, p. 41. 

d This seems a low estimate in spite of the fact that it does not include all 
cases of decayed teeth, but only those tbat have been neglected. See Dr. William 
R. Woodbury, " The People's Disease : How to Prevent it," Boston Medical and 
Surgical Journal, March 26, 1908. 

« " Backward Children in the Public Schools," Philadelphia (Davis), 1908, p. 7. 



fisheb.] NATIONAL VITALITY. 697 

ophthalmologists had defective vision, and of this number 12.5 per cent suffered 
from vision of one-half or less. The author examined personally 1,156 children 
and found 34 per cent with defective vision, and of this number 6 per cent 
with vision one-half or less. A small proportion of this number only is fitted 
with glasses. The rest suffer from real eye strain. The fault of this deplorable 
condition is divided among physicians, school-teachers, and parents. Ignorance 
of the existing facts, indifference, and poverty are the real factors to be dealt 
with. 

Eye strain is the chief source of the functional diseases of our citizens. It 
begins in early childhood and continues until senility is complete. It is bound 
to occur in every individual some time in his life, to a greater or less degree. 
It is almost, the sole cause of headache, migraine, sick headache, the most fre- 
quent and habitually morbidizing of human diseases. It is the frequent cause 
of gastric and digestional diseases and of nervous and mental diseases. With 
ocular function it conditions the origin of spinal curvature, either directly or 
indirectly, through the pathogenic writing posture. Lateral spinal curvature, 
the effect of visual function, becomes a new secondary source of multifarious 
morbidities, such as neurasthenia, pelvic diseases, hysteria, etc. It has been 
demonstrated that 27 per cent of European school children have lateral spinal 
curvature at the age of 14, and I have proved that at least 70 per cent of our 
own 16 to 18 year old young men of the educated classes have this disease. 
Surprise at the fact will soon become horror at the national and social tragedy 
which these true figures indicate. 

Investigations in other cities and States b have shown similar re- 
sults, in view of which it is a conservative statement to say that from 
one-half to two-thirds of our school children need medical treatment 
of some sort. 

At least one year in each division of schooling, elementary, secondary, and 
collegiate, is lost to the majority of students because of unnecessary sickness 
or dullness caused by improper living. 

That physical defects are responsible for much of the backwardness 
of children, and for a large share of truancy and incorrigibility, is the 
opinion of many educators.* In order to correct physical abnormali- 
ties and thereby to hasten mental and moral progress in school life, a 
number of cities have instituted medical inspection of schools. 

So far as inquiry has been able to discover, there were in the month of 
June, 1908, 70 cities in the United States, outside of Massachusetts, having 
some form of medical inspection of schools. In the State of Massachusetts 32 
cities and 321 towns had systems more or less complete. It is at present impos- 
sible to compute, or even to closely conjecture, how many children these systems 
reach at the present time. It is entirely certain that they do not reach all of 
the children in the schools of those cities and towns where systems of medical 
inspection are actually or nominally in operation. 6 

New York City employs 150 physicians, who visit each public school once a 
day, shortly after 9 o'clock, to examine those children set aside by the teacher 

•Letter from Dr. George M. Gould, who perhaps more than any other Amer- 
ican has emphasized the evils of eye strain. 

6 See an article by Prof. M. V. O'Shea in the World's Work, Vol. V, in which 
the results of extensive investigations were given. See also Dr. W. B. Drum- 
mond : "An introduction to child study," Chs. IX and X, " Report of Conference 
of State Sanitary Officers of New York," Buffalo, October, 1907, and various 
Baltimore and New York City school reports. 

c Letter from Mrs. Ellen H. Richards. 

d See O'Shea: "When character is formed," Popular Science Monthly, Vol. 
LI; Rowe: "Physical nature of the child," Chs. 9, 10, 13, 14; Scott: " Sacrifice 
of the eyes of school children," Popular Science Monthly, October, 1907 ; Gould : 
" The cause, nature, and consequences of eye strain," Popular Science Monthly, 
December, 1905 ; Travis : " The Young Malefactor, a Study in Youthful Degen- 
eracy ; " Swift : " Mind in the making," Chs. IV and V ; Tanner : " The child," 
Ch. Ill ; Kirkparrick : " Fundamentals of child study," Ch. XVII. 

'Letter from Dr. Luther H. Gulick. 



698 REPORT OF NATIONAL CONSERVATION COMMISSION. 

as requiring attention. Chicago employs nearly 100 physicians to visit her 
public schools. In Chicago during the ten months of the school year ended 
June 26, 1908, the medical inspectors of schools examined 406,919 pupils. 

And one health officer, Doctor Chapin, *of Providence, has even 
established a special fresh-air school for children who suffer from 
certain forms of tuberculosis or who come from tuberculous families. 
He says concerning it: 

Our fresh-air school has only been running since last January (1908), and, of 
course, we have no very definite results. All of the children without exception 
improved in health, and gained in strength, and also showed good mental prog- 
ress. The cost of the school per capita is only about 50 per cent more than in 
the ordinary schools, and we believe that the expense is fully justified. If we 
had a large enough school, so that it could be graded, the cost of education 
would, owing to saving in fuel, probably be less than in an ordinary school. 

Several States are making progress in these directions. 

Connecticut, Massachusetts, and Vermont have passed laws making examina- 
tion of eyes, ears, and method of breathing of the public scholars compulsory, 
while New York, Illinois, and some other States of the Middle West depend 
upon the voluntary cooperation of the teachers in making this examination. 
It would seem, however, that whether it remains voluntary or becomes com- 
pulsory, its success will be greatly enhanced if women who are conducting 
teachers' institutions in the department of education devote a half hour or an 
hour to the exposition of the necessity of such an examination and also in 
explaining the method in detail and the method of tabulating the results, so 
that the teachers may be familiar with the tests, etc., when they have to make 
them. With the great power lodged in the department of education in this 
State, it would seem justifiable to make this compulsory. 6 

We in this country should profit by the experience of older coun- 
tries in respect to school hygiene. Switzerland has led the nations 
in its concern for the physical welfare of its children. A number of 
other European countries are beginning to imitate Switzerland in 
attaching supreme importance to health and hygiene in educational 
work. There is now before the English Parliament a bill the pur- 
pose of which is to establish a national system of medical inspection 
of schools, and it seems probable that this measure will be enacted 
into law. 

It is generally recognized by physicians and educators to-day that 
many children in the schools are being seriously injured through 
nervous overstrain. Throughout the world there 'is a developing 
conviction that one of the most important duties of society is to de- 
termine how education may be carried on without depriving children 
of their health. It is probable that we are not requiring too much 
work of our pupils, but they are not accomplishing their tasks 
economically in respect to the expenditure of nervous energy. Some 
experiments made at home and abroad seem to indicate that children 
could accomplish as much intellectually, with far less dissipation of 
nervous energy, if they were in the schoolroom about one-half the 
time which they now spend there. German educators and physicians 
are convinced that a fundamental reform in this respect is needed. 
In fact, among school children we are learning the same lesson as 

° A. L. Craig, " Report of the standing committee on contagious, infectious, and 
hereditary diseases," Associated Fraternities of America, August 1, 190S. 

b Twenty-eighth Annual Report State Board of Health of New York, 1908. 

c See Dr. Adolph Meyer, " What do Histories of Cases of Insanity Teach Us 
Concerning Preventive Mental Hygiene during the Years of School Life? " The 
Psychologic Clinic, June 15, 1908. 



fisher.] NATIONAL. VITALITY. 699 

among factory employees, viz, that high pressure and long hours are 
not economy but waste of time. 

In American cities one of the greatest needs to-day, in order to 
conserve the vitality of children, is the establishment of playgrounds 
easily accessible to all the children of any community. We are told 
that the physical and the mental are inseparably joined together, and 
if the one is defective the other will suffer through sympathy. Now 
it appears to be impossible to develop the child physically in any way 
so effectively as through active play. Formal gymnastics can accom- 
plish relatively little. The child must have some end to attain that 
arouses its enthusiasm, and that demands agility and strength and 
endurance; then its whole bodily mechanism will work together in 
harmony to achieve this end. And this is what a physical training 
seeks to accomplish — to make the body a fit instrument for the mind. 
Let the child have some place where it may not only play games 
freely without fear of the police but where it may run and jump 
and climb and swing and work in sand and throw stones and wrestle, 
and it will not fail to make the most out of the body nature has given 
it as a housing for a sound and efficient mind. 

Even if playgrounds were of no value in social development, they 
would still be of inestimable service in keeping children out of crime 
and lessening expense for police, courts, reformatories, hospitals, and 
prisons — a point which was strongly emphasized in the report of 
1897 of the committee on small parks in New York. If a boy's 
energies are not used up in wholesome activity they will surely find 
expression in illegitimate conduct. The boy will prey upon the in- 
stitutions which prevent him from living a natural life. " The great- 
est enemy to the police is the boy," said a high Philadelphia official 
recently. Go to the storekeeper, to the shopkeeper, to the house- 
keeper, and you will hear the same story. The boys steal, break 
windoAvs, insult, afflict, upset one thing and another, and would do 
almost anything they hear or see in order to satisfy that burning 
instinct for play. " These beginnings of vice and crime were the 
only outlets they have had for the powers with which nature has 
endowed them. These practices were their only or chief amusement, 
and thus happiness to them became synonymous with vice and fiendish 
delight in evil doing. " a 

But in studying the life on the playgrounds the same official sees 
that they lay the foundations for — 

strong, manly, bright, and happy lives, rescued from the evil habits and 
tendencies that produce misery and wretchedness. * * * Through their play 
in this manner the young are taught how to live together, how to respect each 
other's rights, how to be kind, gentle, pure, in language as well as in conduct. 
The boy's mouth is not defiled by tobacco, liquor, or profane language. The dis- 
respectful and vulgar treatment which young boys and girls inflict upon each 
other in the street is done away with. The playground influences are brought 
into the home, where the younger brothers and sisters treat each other much 
differently from the way they do now; or, to put it the other way, the influ- 
ences of the home, the school, and of the jhurch are thus extended outside over 
the whole life of the child. 

To playgrounds may be joined school gardens, which Superin- 
tendent Maxwell in New York has shown would not be expensive, 

° Secretary of Philadelphia Culture Extension League. 
S. Doc. 419, 61-2 6 



700 EEPORT OF NATIONAL CONSERVATION COMMISSION. 

or open-air gymnasia, or any other equipment that will give children 
the opportunity to develop physically. 

Physical education is a part of the training in many public schools 
and in a still greater number of private schools, but there is room 
for improvement. After pointing out, in a recent article on physical 
deterioration, that Germany, France, and Austria have improved 
their physical development by compulsory physical training in all 
civil and military educational institutions, the Rev. Percy Stickney 
Grant advocates the instalment in the United States of: 

1. An effective system of r lAv sical education as a recognized part of all public- 
school systems. By " effect.. e" I mean one that does for a boy, as far as 
his physique is susceptible, what army setting-up exercises do for a recruit. 

2. Athletic exercises in schools, using gymnasia, baths, etc. 

3. Open-air exercises and sports under efficient supervision. 

4. Summer camps free of cost, and compulsory attendance for boys of school 
age.° 

The study of hygiene and physiology has been part of the public 
school curriculum for some time, but has been regarded by physiolo- 
gists as a somewhat partisan and unscientific treatment of the physi- 
ological effects of alcohol and tobacco. It should be recognized, how- 
ever, that it has had a salutary effect and has given school children a 
better idea of what alcohol means than the most of them had before. 6 
Local topics of sanitation may well be taken up, as in New Haven 
last year when the interest of all the city school children was enlisted 
in behalf of a " clean city." Doctor Stiles, of the Public Health and 
Marine-Hospital Service, has proposed an annual " health week " in 
the public schools, and this proposal has found favor in several States. 
In Georgia Chancellor Barrow has proposed an annual " health day " 
in the public schools of that State, which would be devoted to lectures 
on sanitation, on the dangers to be expected from unscreened win- 
dows, and on the character of the hook-worm disease, with suggestions 
as to its elimination. 

At present the schools look to parents to instruct their children in the sup- 
posedly simple matters of regulating eating and drinking, exercise, habits of 
work, and sexual habits, while the parents vaguely hope (if they think about 
such matters) to be relieved of these embarrassing duties through the schools. 
The truth is that neither parents nor schools are to-day able to give this much- 
needed sort of education. The remedy must be provided by the schools, which 
in their eagerness to impart conventionalized facts are now quite blind to some 
of the most pressing needs of their pupils. Through the schools and universi- 
ties (or other appropriate organizations) the parents of the future must be edu- 
cated both as to the facts and the moral aspects of bodily hygiene. And it seems 
not unreasonable to hope that some of the lessons now learned only by bitter 
experience, after much that is best in life has been sacrificed to ignorance and 
uncurbed impulse, will be assimilated sufficiently early in life to mitigate mate- 
rially the lot of a not inconsiderable part of mankind. I believe the lengthening 
of the span of human life to be among the attainable results of such teaching. 
Is it not likely that as men grow wiser an increasing number will deliberately 
strive so to regulate their lives as to improve the expectation of crowning well- 
spent days with the peculiarly fine satisfaction of old age? c 

If the school building were a model of ventilation, lighting, and 
sanitation, it would not only conserve the health of the school chil- 



° Rev. P. S. Grant, North American Review, February 1, 1907. 

b See Dr. Helen Putnam, " Studies of the Present Teaching of Hygiene, 
Through Domestic Science and through Nature Study," American Academy 
Medicine (Easron, Pa.), 1905. 

c O. A. Herter, M. D., " The Common Bacterial Infections of the Digestive 
Tract," New York (Macmillan), 1907, p. 351. 



fisher.] NATIONAL. VITALITY. 701 

dren, but also serve as an object lesson for hygienic instruction. In 
the same way cooking and domestic science classes could be made to 
serve the double purpose of providing a hygienic noon meal and 
training the school children, especially the older girls, in the princi- 
ples and practice of this vitally important subject. Our schools are 
suffering from the conventional idea that education comes from 
books. Education is preparation for life, and should make use of 
every efficient method and element, manual training, athletics, ob- 
servational nature study, laboratory experiments, and object lessons 
of all sorts, as well as book instruction. 

Section 5. — Voluntary and business organizations. 

A host of distinctly voluntary associations are working for the 
improvement of hygienic conditions. Among them may be men- 
tioned the National Association for the Study and Prevention of 
Tuberculosis, the Society for Sanitary and Moral Prophylaxis, the 
Chicago Society of Social Hygiene, the Connecticut Society of Men- 
tal Hygiene, the national and state child labor committees, the Con- 
gress on School Hygiene, the Children's Aid societies, the Sunshine 
societies, the American Playground Association, the Visiting Nurses' 
Association, the Bed Cross Society, the American Association for 
Labor Legislation, the numerous temperance organizations, univer- 
sity settlements, institutional churches, Young Men's Christian Asso- 
ciation and kindred associations, the American Physical Education 
Society, the Boston Health Education League, and the American 
Health League established by the Committee of One Hundred on 
National Health. 

That various large bodies of men are waking to the importance 
of health study is shown by the appointment, at the last annual 
meeting of the Associated Fraternities of America, of a committee 
on infectious, contagious, and hereditary diseases, with Doctor Craig, 
of Chicago, as chairman. Labor unions may well follow this exam- 
ple and provide for the education of their members in the subject 
of hygiene.- This could be effectively combined with their endeavors 
to shorten the hours of labor. Especially unhygienic is the arrange- 
ment by which a man has no interest in his work beyond that 
represented by his pay envelope. This fact has been recognized by 
some farsighted employers of labor, with the result that they now 
employ social secretaries or " welfare workers " to look after the 
general well-being of employees. A social secretary watches over 
the health, comfort, and happiness of the force during working hours, 
establishes lunch rooms, rest rooms, mutual aid associations, thrift 
funds, and penny provident banks. Employers, as a rule, become 
eager for practical suggestions and expert advice on the well-being 
of their employees as soon as the matter is called to their attention. 
Doctor Favill, president of the Chicago Tuberculosis Institute, after 
speaking before the Commercial Club, was urged by 15 or 20 of the 
large employers present to undertake investigation of their estab- 
lishments and to make recommendations. 

Dr. Hubert Higgins describes an interesting experiment carried 
out in a mill near Paris, where there were employed 44 men and 75 
women and children. A medical officer was employed to supervise 
the sanitary appliances and regulations and to give careful instruc- 



702 REPORT OF NATIONAL CONSERVATION COMMISSION. 

tion and explanations. He held practical instruction classes with 
the mothers, lecturing on diet and cooking, cleanliness, the way to 
take body temperatures, and how to look at the children's throats. 

This experiment was entirely successful, though the doctor lived in Paris. 
There was not a single death in three years. There wej*e one or two cases of 
scarlet fever and diphtheria, that were promptly and effectively isolated. This 
experiment was not philanthropic, but financial, the employer realizing that 
he had better value in work from healthy hands. 

A few factories now use or permit the use of a reader to read to 
their employees, where the manual nature of their work is such as 
not to be hindered by listening to a story. Others use a piano and 
have their employees march in and out to music. The curious 
physiological relations between rhythm and work are now being 
observed by physiologists. Laboratory tests with ergometers seem 
to show that more work can be done under the stimulus of rhythm. 
Soldiers and sailors have for ages made use' of music and rhythm, and 
it would not be beyond the range of possibility if the factory system 
should in some cases find more use for it than at present. 6 

Unconsciously, business corporations have also made changes which 
tend to improve the sanitary conditions under which their employees 
work. In a large telephone exchange in Chicago the perfect working 
of the apparatus was much hampered by dust, so that insulation was 
seriously affected. To obviate this condition an expensive system 
was put into operation, by which the air was washed and pumped 
into the rooms under ideal conditions. What the company aimed at 
was the perfect health of its apparatus, but it gained in addition a 
decided improvement in the health of its employees. 

Another similar organization, the New England Telephone and 
Telegraph Company, at Cambridge, Mass., ventilated its offices 
during the winter of 1907-8 with unusual care, with the result that 
the number of days of work lost by its 60 female employees was cut in 
half. 

The need of industrial efficiency is driving business men to de- 
mand temperance or even total abstinance among their employees. 
This is one of the most powerful motives to-day working against the 
abuse of alcohol. Id the South employers and the public see that 
negroes who drink are inefficient and dangerous. Railway officers 
and the traveling public realize that public safety requires sober 
locomotive engineers and firemen. Even drinking among sailors is 
being discountenanced. Doctor Grenfell, the missionary among the 
Labrador fishermen, says : " Why don't I want to see liquor used at 
sea? Because when I go down for a watch below, I want to feel 
that the man at the wheel sees only one light when there is only one 
light to see." 

Among semipublic institutions with power to exercise prodigious 
influence in improving the public health are the life insurance com- 
panies. Just as fire insurance companies make efforts to decrease 
the risk of fire, so life insurance companies might well join in public 
health movements to effect a reduction in the human death rate. 

While the financial motive is sordid, it should be utilized because 
of its tremendous power. The insurance companies to-day represent 

° Hubert Higgins, " Humaniculture," New York (Stokes), 1906, pp. 209-211, 
6 See Karl Biicher, "Arbeit and Rythmus," Leipzig, 1902. 
• See Outlook, May 26, 1906, 



fishhb.] NATIONAL VITALITY. 703 

an invested capital of over $3,000,000,000. An actuary recently re- 
marked to me, in connection with this subject, that they could without 
feeling it contribute great sums annually to the preservation of public 
health. When insurance companies were established, the old dictum 
that human vitality followed a fixed law served probably to exclude 
the idea of preventing death claims rather than paying for them. 
Now that we are learning the preventability of disease, the time must 
come when insurance companies will take an active part in the fight. 
Even a single company would probably make a good investment if 
it sought to educate its own " risks." But a far more effective method 
wmild be a combination of all companies to improve public health 
through the enactment of public legislation — by Congress, state legis- 
latures, municipal governments, and in numberless other ways.- 

Among some official agencies meant to promote the social welfare 
are two recent commissions appointed by the President — the Homes 
Commission, of 1907, appointed for the purpose of studying the hous- 
ing conditions in the District of Columbia, and the Commission on 
Country Life, appointed to study the daily life of the farmer. Farm 
sanitation will be especially considered. 

Finally, there is a public yet voluntary agent in the progress of 
hygiene that must not be overlooked, namely, the modern periodical. 
Not only do the daily papers devote much attention to questions of 
health and hygienic reform, but the popular magazines have taken up 
the fight against disease, and are educating the popular mind, more 
surely than is realized, concerning the natural and normal way of life. 
It is necessary to add, however, that these same periodicals often 
nullify the benefits derivable from their reading matter by printing 
the most harmful of patent medicine, quack, drug, and alcoholic ad- 
vertisements. Public odium should attach to newspapers and maga- 
zines that advertise hurtful nostrums. It is impossible to estimate 
the harm wrought to the public health each year through such ad- 
vertising. 6 

The daily papers are especially culpable in this regard, but weeklies 
and monthlies are not wholly clear of the taint. When a newspaper's 
advertising space is once bought by quacks or nostrum sellers, its news 
columns become closed at once to matter considered objectionable by 
such advertisers. Frequently news items reflecting directly or indi- 
rectly on quackery are suppressed. Notable examples of publications 
that have taken strong ground against such advertising are Collier's 
Weekly, The Outlook, The Ladies' Home Journal, and a few — a very 
few — daily papers. 

° Since the above was written the Committee of One Hundred on National 
Health has urged this matter before the Association of Life Insurance Presi- 
dents, which body has appointed a committee to draw up plans. Also the Metro- 
politan Life Insurance Company has organized a bureau of cooperation and 
information to aid in distributing information to policy holders of the " indus- 
trial " class. 

6 For further discussion of this topic see a pamphlet by Samuel H. Adams on 
" The Great American Fraud," reprinted by the American Medical Association 
from a series originally appearing in Collier's Weekly, and "A Century's Crim- 
inal Alliance between Quacks and Some Newspapers," by Champe S. Andrews, 
Publications of the Committee of One Hundred, 1907. 



704 REPORT OP NATIONAL CONSERVATION COMMISSION. 

Chapter IX. — Conservation through personal hygiene. 

Section 1. — Its importance. 

Following public and semipublic hygiene, we arrive at what is in 
many respects the most important subject of all, personal hygiene. It 
is quite true that the individual is often at the mercy of unclean 
streets, bad drainage, impure water and food, and other shortcomings 
of public and semipublic hygiene. On the other hand, his own per- 
sonal interest is necessary in order to form the public opinion which 
alone can result in effective public and semipublic hygiene, while that 
interest is still more necessary to make such hygiene apply directly to 
his own person. Clean streets are of use only as they make the air 
breathed purer, but they are of little avail to the household which does 
not ventilate its rooms or which keeps them in a state of filth. The 
milk supply of a city may be ideal, but all the pains to make it so 
will be set at naught if the individual consumer allows the milk to be 
contaminated after it is delivered. The labeling of foods and drugs 
will not prevent self-poisoning through alcohol, nor will the elimina- 
tion of preservatives from foodstuffs and the enforcement of sanita- 
tion in their manufacture be of avail if in their preparation for the 
table they are subjected to disease and dirt. Thus at every point of 
hygienic progress, there must be individual cooperation with public 
efforts. 

When, contrariwise, health organizations and officials are inefficient, 
the individual may, in spite of these difficulties, often maintain good 
health. In New York a woman who was the occupant of a tenement 
overcame tuberculosis by sitting daily on her fire escape. The air 
was not the best, but it was much better than indoors. Similar results 
have been obtained by workmen in Brockton shoe factories, who, in 
spite of insanitar} 7 working places, and without cessation of work, 
conquered tuberculosis by sleeping on the roofs of their houses at 
night. 

Observation shows that many, possibly most, of the world's most 
vital men and women have virtually made over their constitutions 
from weakness to strength. Cornaro, the famous nonogenarian, Kant, 
and Humboldt are cases typical in different fields of achievement. 
Cornaro, a Venetian nobleman born about the middle of the fifteenth 
century and given up to die at the age of 37, forswore all unhygienic 
habits and began to live " the temperate life," his abstemiousness 
applying especially to food. His age at death is variously estimated, 
but he lived to be at least 97. When over 90 he wrote a treatise on 
longevity, laying down as the chief rules of a normal life, care in 
eating and drinking, and the avoidance of melancholy and passion." 

Centenarians have usually been persistent followers of some rule or 
rules of rational hygiene, even though unconsciously. 5 

Metchnikoff points out c that part of the supposed inheritance of 
longevity may not be inheritance, but similarity of environment, and 
that it very frequently happens that husband and wife both live to be 

See L. Cornaro, " The Art of Living Long " ( English translation, Wm. F. 
Butler, Milwaukee), 1903. 
* Metchnikoff, "The Prolongation of Life," p. 141. 
o Ibid., p. 86. 



fishbe.] NATIONAL. VITALITY. 705 

over 100. This could scarcely happen by accident, but must be due to 
similar habits or environment. 

Humboldt confessed to a fellow-student that in the first years of 
his childhood his tutors were doubtful whether even ordinary powers 
of intelligence would ever be developed in him, and that it was only 
in the advanced part of his boyhood that he began to show any evi- 
dence of mental vigor. As a boy he suffered from debility which not 
infrequently produced great prostration. 

Of recent examples may be mentioned a young physician who was 
given up to die of tuberculosis five years ago, but who to-day can 
run 25 miles without a rest ; and Horace Fletcher, who in his 46th year 
was rejected for life insurance, but who later not only obtained his 
insurance, but proved his powers of endurance by cycling 190 miles 
on his 50th birthday. 

And not only can weakness, if recognized early enough, be turned 
into strength, but strength, however great, may be dissipated in an 
incredibly short time. 

Personal hygiene means the strengthening of our defenses against 
disease. Public hygiene seeks to destroy the germs before they reach 
our bodily defenses. These two branches of hygiene are simply the 
two forms of warfare, defensive and offensive. Both are of tran- 
scendent importance, but the defensive warfare is more within our 
power. We always have our defending garrison, the white blood 
corpuscles, to deliver us from our enemies. 6 

Section 2 — Branches of personal hygiene. 

Personal hygiene comprises hygiene of environment (air, soil, 
dwelling, clothing) ; hygiene of nutrition ; and hygiene of activity. 

Man is more dependent upon the atmosphere than upon any other 
environmental factor. His body is bathed in air and his most vital 
function, respiration, depends upon it. Deprived of air, he will 
shortly suffocate. If the air is confined and impure, his health will 
be affected. Ideal air should first of all be pure — i. e., free from in- 
jurious bacteria, from dust, smoke, and noxious gases. It should 
also conform to certain standard conditions of humidity and tem- 
perature. In this field lie the sciences of climatology and meteor- 
ology. Man learned long ago how to make himself almost inde- 
pendent of climatic and atmospheric conditions by the use of dwell- 
ings and clothing. These contrivances, however, while protecting 
him from the elements, have brought evils of their own. The great 
scourge of tuberculosis, for instance, is principally an indoor disease. 

Intimately related to the appropriation, through the lungs, of oxy- 
gen from the atmosphere is the ingestion of food and drink through 
the alimentary canal. Normal health conditions demand in the case 
of ingested materials, as in the case of respired air, the greatest possi- 
ble purity, freedom from injurious bacteria, and the absence of sub- 
stances hurtful mechanically or chemically. 

Finally, the ideal conditions of health require perfect balance of 
work, play, and sleep. 

° " Life of Alexander von Humboldt," by Lowenberg Are-La 11 ewort and Dore, 
translated by Jane and Caroline Lassell, New York (Lee & Sliepard), 1873, 
*"ol. I, f»p. 30^32. 

* Metchnikoff, " The New Hygiene," p. 14. 



706 REPORT OF NATIONAL. CONSERVATION COMMISSION. 

While absolutely perfect conditions in these three branches of hy- 
giene are unobtainable, hygienic progress consists in approaching 
these ideals as closely as possible. 

The rules of personal hygiene are expressed in standard medical 
works on the subject. There is nothing novel in the brief resume 
which follows. The radical changes in habits of living which are 
now being advocated and to some extent practiced imply nothing 
new. They have, for the most part, long been commonplaces of the 
medical profession. The knowledge is old. It is the application 
which is new". Medical men have long been telling their patients to 
get plenty of fresh air and to masticate their food. But until re- 
cently their advice has fallen on deaf ears. 

Section 3 — The hygiene of environment. 

Air hygiene deals first of all with ventilation. The importance of 
properly ventilating houses is so great that to secure this end the ar- 
chitecture of houses will have to be changed. The worst historical 
instances of bad ventilation are the imprisonment and virtual suffoca- 
tion of 146 persons in the " Black Hole " of Calcutta and the confine- 
ment of 300 men in an underground room after the battle of Auster- 
litz. The evils of overcrowding come mainly from exhaled air and 
from the effluvia thrown off by the skin. Not only does overcrowding 
bring bad air, but it also increases the opportunity for infection. 

The air in our houses has impurities of its own. Oil and gas vitiate 
it. Electric lights are hygienic in this respect. Air is never quite 
free from dust impurities. Aitkin estimates that country air carries 
2,000 dust particles per cubic centimeter, city air 3,000,000, and in- 
habited rooms 30,000,000. 

In a clean hospital ward, when air was agitated by dry sweeping, 
the number of colonies of bacteria collected on a given exposure rose 
from 26 to 532, showing the effect of ordinary broom sweeping. The 
broom is now being replaced by the carpet sweeper, and the carpet 
sweeper in turn by the vacuum cleaner. Each step represents progress 
in the elimination of dust. The removable rug is in this regard an 
improvement over the carpet. 

Air may even be poisoned by the chemicals contained in wall paper 
or in the plaster of a brick and mortar dwelling. 

The one place where the individual has more control over the air 
he breathes than anywhere else is his sleeping room. He may be 
powerless to control the air in his place of work, or even in the rooms 
where he lives during the day. But, except where he shares a bed- 
room with others who are averse to modern ideas of ventilation, he 
can largely control the air supply during sleep, and this means during 
one- third of his whole time. He can open wide his windows and in 
many cases arrange actually to sleep out of doors. The growing prac- 
tice of sleeping out of doors is one of the most significant signs of the 
times. Only those who have tried it realize the benefits. The air 
supply in public places would be under the control of individuals, if 
organized in protest ; and our churches, theaters, public halls, railway 
coaches, and railway sleepers would be properly ventilated if the 

•See Richards andl Woodman, "Air, Water, and Food," New York (Wiley), 
1904; also Carpenter, " Heating and Ventilating Buildings," New York*( Wiley), 
1905; Sykes, " Public Health and Housing " London (King), 1901, 216 pp. 



fisher.] NATIONAL, VITALITY. 707 

public demanded improvement. Such a " score card " as Prof. John 
R. Commons has devised for measuring the relation of housing con- 
ditions to an ideal standard might well be used in measuring the 
health utility of public places. 

The windows of living and work rooms may be opened in summer 
and somewhat in winter, provided a window board is used, to deflect 
the cold air upward from the sill. It then does not form a cold 
stratum on the floor, but mixes evenly with the air of the room. This 
simple device would go far to solve the question of winter shut-ins 
and their ailments. In many cities sleeping balconies are not uncom- 
mon among the dwelling houses. 

The many benefits from a pure air supply are only beginning to be 
realized. For instance, as long as " the outdoor life " is lived a cold 
is almost impossible. Army officers have noted that as long as the 
men are on the march and sleep outdoors they hardly ever have colds, 
but that they become troubled with these as soon as they get indoors. 
Franklin, a century ago, knew these facts, though few of the present 
generation are acquainted with them. He believed " that people who 
live in the forest, in open barns, or with open windows, do not catch 
cold, and that the disease called ' a cold ' is generally caused by impure 
air, lack of exercise, or from overeating." He came to the conclusion 
that influenzas and colds are contagious — a doctrine which, a century 
and a half later, was proved, through the advance of bacteriological 
science, to be sound. The following sentence exhibits remarkable in- 
sight, considering the state of medical art at that time : a I have long 
been satisfied from observation that besides the general cblds now 
termed ' influenzas ' (which may possibly spread by contagion, as well 
as by a particular quality of the air), people often catch cold from 
one another when shut up together in close rooms and coaches, and 
when sitting near and conversing so as to breathe in each other's 
transpiration; the disorder being in a certain state." In the light of 
present knowledge what a cautious and exact statement is that. a 

John Muir, the geologist and naturalist, says that he finds home 
the most dangerous place he can visit. 

As long as I camp out in the mountains without tents or blankets I get along 
very well, but the minute I get into a house and have a warm bed and begiu to 
live on fine food, I get into a draft, and the first thing I know I am coughing 
and sneezing and threatened with pneumonia, and am altogether miserable. 

Atmospheric evils come from improper ventilation, and affect either 
the respiratory organs of the body or the skin. It has been supposed 
until recently that the presence of carbon dioxid gas in vitiated air 
was the chief evil caused by such air. Impure air will affect the 
lungs harmfully, but not till the amount of carbon dioxid con- 
tained is very large. Guinea pigs, on which the effects of bad air 
were observed, were not seriously affected by the carbon dioxid till 
it amounted to 14 per cent of the volume of the air. Fliigge and 
others have found that the evil of close atmospheres is largely a result 
of elevated temperature, humidity, and absence of air currents. Tests 
were made on men who sat in impure air, but breathed pure air 
through tubes, and they presented all the symptoms usually resulting 
from bad ventilation. 



° From " Benjamin Franklin as Printer and Philosopher," address of Presi- 
dent Charles W. Eliot before American Philosophical Association, April 20, 1906. 



708 BBPOBT OF 'NATIONAL. CONSERVATION COMMISSION. 

Air baths have been shown to be as important for bodily health as 
water baths. For this purpose porous clothing should be worn and 
no more of it than is needful. Impervious cloth and rubber are prob- 
ably injurious as clothing. Loosely woven worsteds, or linen and 
cotton mesh are best adapted to let the air play on the skin. Clothing, 
to be hygienic, should not constrict the body. Tight shoes, and 
especially tight corsets, are distinctly injurious, and the injury to 
mothers from the latter may be felt by the next generation. Another 
insanitary feature in clothes is the trailing skirt, which drags indoors 
the sputum of consumptives and germ-laden dirt from the sidewalk. 

Closely connected with air and ventilation is light. The benefit of 
sunshine in killing germs and improving bodily vigor in every way 
is too well known to need more than mention. Tuberculosis and other 
germs thrive only in dark, damp, ill- ventilated places. 

Light has its most important bearing on the human health through 
the sense of sight. Its relation to eye strain has been discussed else- 
where. Headaches, backaches, indigestion, hysteria, and epilepsy are 
often aided by glasses. 

Section 4. — The hygiene of nutrition. 

A primary necessity for hygienic living is good drinking water. 
The modern man of means insists upon good water, and, as a result, 
the traveling public is now able to get first-class water in cars, hotels, 
and other public places. The improvement was brought about by 
the appreciation by the consumer of the danger of drinking impure 
water. It is the consumer who has it in his power to bring about the 
necessary reforms in public hygiene. When he really values hygienic 
environment producers will supply it. Professor Sumner has told us 
that persons in the middle ages sometimes drank out of their castle 
moats, which contained sewage. Even in New York to-day the roof 
tanks are sometimes used as baths or laundries; and they accumu- 
late dust and flies very rapidly. Only a few years ago the aldermen 
in a prominent western town laughed out of court a physician who 
called their attention to dangers which were real, but which they be- 
lieved imaginary, from a polluted water supply. 

The scientific study of diet has only just begun and few authori- 
tative results can yet be stated. To avoid a lengthy review of 
controversial literature it seems best to pass the subject over rapidly, 
referring the reader for further information to some of the principal 
books on the subject. 

We have already seen the surprising improvement in endurance 
which followed the adoption of thorough mastication in place of the 
ordinary food bolting. Mr. Gladstone used to be noted for his care 
in slowly masticating his food, and latterly Mr. Horace Fletcher has 
aroused the interest of the public in the subject in Europe and Amer- 
ica. He has also stimulated a large number of physiologists to study 
the subject of mastication, the protein ration, and their relation to 
strength and endurance. 

a See Horace Fletcher, " The A, B-Z of our Own Nutrition," New York 
(Stokes), 1903; Dr. Hubert Higgins, " Humaniculture," New York (Stokes), 
1906; and Irving Fisher, "The Effect of Diet on Endurance," publications of 
Yale University, Transactions of the Connecticut Academy of Arts and Sciences, 
1807. 



nsHU.] NATIONAL, VITALITY. 709 

A great deal has been written as to what foods are best There 
exist various dietetic cults, such as vegetarians and fruitarians, raw- 
food advocates, etc. The question of what foods are ideally best is 
too large a one to be entered upon here. The evidence seems to point 
to a general conclusion that no hard-and-fast rule of exclusion is 
advisable, and that the value of different foods varies with the indi- 
vidual and with his activity, locality, physical condition, etc. His 
own instinct, restored and educated by avoiding the pernicious habit 
of food bolting, may be made a truer guide than the wisest physician 
or physiologist. The same rule applies to the amount of food to be 
eaten, as well as to the proportions of protein, fat, carbohydrates, 
and mineral salts. Food bolting often leads to overeating. 

It should be noted that the conclusions of Chittenden and others 
are not in favor of a vegetarian regime, but of a low protein regime, 
whether vegetarian, lacto-vegetarian, or with flesh foods in modera- 
tion. The main point is moderation of the foods highest in protein, 
such as the whites of eggs and meats (especially lean meats). 

It would seem that the safest course for the average man is to fol- 
low the appetite, simply guiding it toward a low protein diet by thor- 
ough mastication, and by giving the benefit of the doubt to foods low 
in protein. A reduction in the use of meat will increase, and probably 
cheapen, our national food supply. The raising of cattle requires 
much more land than the raising of cereals, fruits, nuts, and vege- 
tables yielding the same amount of food value. As this will be a most 
important economic problem during the next hundred years, the ques- 
tion of the character of our food supply should be most carefully 
considered in the study of the conservation of natural resources. It 
is interesting to note, in this connection, that during the last century 
the consumption of flesh foods in the United States has considerably 
decreased. 6 

The subject of auto-intoxication as a consequence of excessive pro- 
tein has already been mentioned. To avoid auto-intoxication the 
putrefactive bacteria may be neutralized by lactic bacilli, such as are 
contained in sour milk. Another preventive is regular attention to 
thorough evacuation. 

Diseased foods are, needless to say, dangerous. Oysters are often 
planted in waters polluted with sewage, with the result that epidemics 
of typhoid fever have been traced to their consumption. 

The housewife must be the guardian of the family in these respects, 
and in the cooking, preparation, and arranging of food generally. 
These now constitute " domestic science," which is justly winning 
recognition as one of the most potent of all hygienic agencies. When 

a For a short method of measuring these magnitudes, see Irving Fisher, "A 
New Method of Indicating Food Values," American Journal of Physiology, Vol. 
XV, No. V, April 2, 1906; and for its practical application see "A Graphic 
Method in Practical Dietetics," Journal American Medical Association, Vol. 
XLVIII, April 20, 1907. See also, " Statistics of Diet in Consumptive Sana- 
toria," American Journal Medical Sciences, September, 1906. 

6 See G. K. Holmes, " Meat Supply and Surplus," Bureau of Statistics, De- 
partment of Agriculture, Bulletin 55, 1907, p. 47. Mr. Holmes finds that the 
consumption of dressed meat per capita in the United States decreased between 
1840 and 1900, 40 per cent, and between 1890 and 1900, 25 per cent. 

c Supra, Chap. V. See also Herter's " Common Infection of the Digestive 
Tract" 



710 EEPORT OF NATIONAL CONSERVATION COMMISSION. 

the kitchen becomes a scientifically conducted laboratory we shall 
have the basis of a sound " home economics." 

Section 5. — Drug habits. 

It would scarcely be an exaggeration to say that the first rule of 
hygiene is to avoid poisons. Poisons may be generated within us 
or ingested from without. 

Drug habits take numerous forms, and they are more prevalent 
than most persons realize. The commonest form of intoxication is 
alcoholic. It is interesting to observe the change which has come 
about in the attitude of scientists toward alcohol. From having en- 
joyed a high place in materia medica, it is in danger of being com- 
pletely discredited. 6 So far as its habitual use is concerned the only 
question which remains in debate is whether in minute quantities it 
may be innocuous or even beneficial. In any except minute quantities 
it has been shown to be injurious. 

It lowers the resistance of the white corpuscles, which are the natural de- 
fenders of the body. Although the phagocytes belong to the most resistant 
elements of our body, yet it is not safe to count on their insensibility toward 
poisons. It is well known tbat persons who indulge too freely in alcohol show 
far less resistance to infectious diseases than abstemious individuals. 

Here is the gravest indictment that may be brought against the 
abuse of alcohol. It is not, however, the only one. The relation of 
drinking to insanity , d peripheral neuritis, Bright's disease, cirrhosis 
of the liver, inflammation of the stomach, arteriosclerosis (a most 
common cause of apoplexy ), e tuberculosis; ' to crime in all its forms^ 
and to all the possibilities incident to the hereditary transmission of 
a weakened organism ll has been pointed out. If personal hygiene 
is a duty, it is the duty of every man to recognize the danger from 
alcohol to himself and to his progeny yet unborn. Instead of copying 
the habits of others, he may consider the responsibility of causing 
others to copy his. 

A subcommittee of the Committee of Fifty for the investigation 
of the liquor problem published in 1899 a volume on the economic 

a For a discussion of the physiological effects of alcohol, see Physiological 
Aspects of the Liquor Problem, investigations made under the direction of 
W. O. Atwater, John S. Billings, H. P. Bowditch, R. H. Chittenden, and W. H. 
Welch, subcommittee of the Committee of Fifty ; New York, Houghton & Mifflin, 
1903, 2 vols. ; and The Liquor Problem, a Summary of Investigations Conducted 
by the Committee of Fifty, 1893-1903, by John S. Billings, Charles W. Eliot, 
Henry W. Farnam, Jacob L. Greene, and Francis G. Peabody, 1905. 

6 The role of alcohol as a predisposing cause of disease has already been noted. 
It has long been known that drunkards have a very slim chance of recovery when 
attacked by pneumonia, and it is noted also that the mortality among moderate 
drinkers is higher than among total abstainers. This fact has long been 
known to life-insurance companies as holding good for many diseases other 
than pneumonia. Osier : Modern Medicine, Vol. II, p. 628. 

c Metchnikoff : The New Hygiene, p. 25. 

d See " Twenty-sixth Annual Report of Massachusetts Bureau of Labor," 1905. 

e Ditman, loc. cit, p. 47. 

f See John Huber, M. D., " Predisposition to tuberculosis," The Medical News, 
December 26, 1903, p. 12. Also reports of Phipps Institute, Philadelphia. 

9 See Boies's various works, the " Reports of the Committee of Fifty," and Re- 
port of the Massachusetts Bureau of Labor Statistics, 1895. 

n See Henry Smith Williams, M. D., "Alcohol and the Individual," McClure'i 
Magazine, October, 1908, pp. 704-712. 



fisher.] NATIONAL VITALITY. 711 

aspects of the problem. The investigation covered a period of about 
three years and was carried on under the general direction of Prof. 
Henry W. Farnam, of Yale University. The general conclusions of 
this investigation were that of the poverty which came under the 
notice of the charity organization societies about 25 per cent could 
be traced directly or indirectly to the use of liquor; of the poverty 
found in almshouses, about 37 per cent. In the investigation of 
crime, the conclusion was reached that liquor was a first cause in 31 
per cent of the criminals studied, and that it entered in as a cause, 
directly or indirectly, in 50 per cent. 

The investigation made by the Massachusetts bureau of statistics of 
labor in 1895 indicated the following percentages due to alcoholism: 

Per cent. 

Crime 84.41 

Pauperism 48 

Insanity 35 

Several English life-insurance companies — the Sceptre, the United 
Kingdom, and General Provident and others — have found by their 
statistics, running over forty years, that abstainers have a death rate 
about 23 per cent lower than nonabstainers. a Since the figures of the 
Mutual Life Insurance Company of New York & give the same advan- 
tage to American abstainers (23 per cent lower death rate), it seems 
fair to take the available computations of the English life insurance 
companies as a basis for estimating the saving of life that would 
result in the United States if individuals should decide to give up the 
use of alcohol. It should be remembered, however, that the favorable 
figure of total abstainers is partly due to the fact that as a class 
they practice personal hygiene in all its forms. 

A basis for computing the sickness that might be saved by total 
abstinence is furnished by comparison between the sick rates of 
abstaining and nonabstaining societies, made by Mr. H. Dillon 
Gouge, public actuary of South Australia, in 1892. He found that 
the average weeks of sickness in three societies of abstainers was 
1.248 ; in three societies of nonabstainers the average weeks of sick- 
ness was 2.317 (lacking only one-sixth of being twice as much). 

Absinthe in France has become almost as clearly a cause of national 
degeneration as opium in China. Fortunately for our own country 
there exists here a more determined effort than in most, if not all 
other nations, to be rid of alcoholism. The movement has been 
formidable enough to arouse anxiety among those whose capital is 
invested in breweries, distilleries, and saloons. The movement 
reaches its maximum momentum in the west and the south of the 
United States. It is significant of the rapid change of sentiment in 
regard to the liquor question that physiologists, physicians, educators, 
and publicists are now becoming so thoroughly impressed with the 
importance of suppressing the evils of alcohol. 

The younger members of the Kaiser's family in Germany are 
opposed to the German habits in regard to the use of alcohol, and the 
son of the Kaiser chose for his university one where there was less 

° Letter from Miss C. F. Stoddard, secretary of the Scientific Temperance 
Federation. 

6 " Effect of Total Abstinence on the Death Rate," by Joel G. Van Cise, actu- 
ary of the Equitable Life Assurance Company of the United States. 



712 EEPORT OF NATIONAL CONSERVATION COMMISSION. 

drinking than at other universities. President Eliot, of Harvard 
University, has recently taken a strong position against the use of 
alcohol, even " in moderation." 

Another common, though less injurious, source of self -poisoning 
is tobacco, which is known to stunt the growth of the young, to lead 
to sluggishness and weakened hearts (" tobacco hearts ") , and to cause 
dyspepsia and neurasthenia. 

Snuff taking has almost disappeared as a habit in this country. 
Chewing tobacco is still common, though no longer defended by 
hygienists. " Inhaling " is more common, though also usually con- 
demned on grounds of health. Smoking shows no signs, as yet, of 
decreasing. In moderation it may not be injurious. There are no 
definite proofs on either side. But smokers are seldom moderate. 

Doctor Seaver, of the Yale Gymnasium, found that of the 187 men 
in the class of, 1891, Yale College, those not using tobacco during the 
college course had gained over the users of tobacco in weight 32 per 
cent, in height 29 per cent, in growth of chest 19 per cent, and in lung 
capacity 66 per cent." 

Similar returns for the Amherst graduating class of 1891 showed 
a gain by the nonusers of tobacco of 24 per cent in weight, of 37 per 
cent in height, and of 42 per cent in growth of chest. In lung capac- 
ity the tobacco users had lost 2 cubic inches of air space, while the 
nonusers had gained 6J cubic inches. 

The somewhat injurious effect of tea, coffee, and condiments, 
though less than many other evils, should be included in any list 
of the imperfections in respect to hygiene of existing habits of life. 

Section 6. — Activity hygiene. 

Only a generation ago there were scarcely any gymnasia in this 
country, but to-day the importance of regular exercise and bathing is 
recognized by everyone. This is far from saying, however, that this 
important method of conserving our vital resources has more than 
begun to be exploited. 

First, the bath for the well-to-do, and, latterly, the public baths for 
the poor, have given all an opportunity to obtain the cleansing and 
healing agency of water. And in recent years the application of 
baths has become a science. 5 

Baths may be used as social agents. Judge Ben. B. Lindsey, of 
the Denver juvenile court, insists that every child must take a bath 
before appearing in the court room. Neutral baths, i. e., baths regu- 

° Doctor Anderson, of the Yale Gymnasium, finds similar results. He also 
points out a statistical pitfall into which some investigators have fallen. This 
is the common statistical fallacy of selection. There are two great groups of 
college students, roughly distinguished as athletes and scholarship men. (See 
Doctor Sargent, " Physique of scholars, athletes, and the average student," 
Popular Science Monthly, September, 1908.) Smoking is more common in the 
former group. They are not athletes because they smoke, but smoke because 
they are athletes. The raw figures of smokers and nonsmokers usually show 
that the smokers have better physical development, but if we compare the 
smoking athletes with the nonsmoking athletes and the smoking scholarship 
men with the nonsmoking scholarship men the results are quite different. For 
similar statistical fallacies, due to failure to subgroup properly, see Mayo- 
Smith, " Statistics and Sociology," Macmillan, 1895. 

6 See J. H. Kellogg, M. D., "Rational Hydrotherapy," Philadelphia, 1904. 



fishjdr.] NATIONAL. VITALITY. 713 

lated to the temperature of the body, have been found valuable in 
relaxing the nerves of the body, and even in the treatment of mental 
disease. 

As to exercise, a healthy organism must call into play every func- 
tion daily, both mental and physical. One of the evils of the division 
of labor which civilization has brought is that the sedentary worker 
does not have enough physical exercise, but too much mental exercise, 
while the situation is just the opposite in the case of the workingman. 

A well-known physical director, now nearly 50 years old, writes me 
that he has this year taken up systematic physical training, which 
he has neglected for several years because of pressure of work. As 
a result his weight has risen, his chest and arm girths have increased, 
while his waist girth has decreased, and he is conscious of decided 
improvement in memory and in sleep. This instance is cited as an 
example of the physical development possible in a man of middle 
age. 

In its bearing on exercise, the growth of modern athletics and its 
effects on the physical ideals of men and women is to be welcomed. 
The revival of the Olympian games and the spread of popular par- 
ticipation in such outdoor sports as golf, tennis, boating, and horse- 
back riding have all had their share in building up a new health 
ideal. Thus Ave are getting away from the mediaeval idea of morti- 
fication of the flesh and approaching more closely the Greek concep- 
tion of a beautiful body as the covering for a beautiful soul. The 
Greeks lifted their sports to a higher level than ours by surrounding 
them with imagination and making them a training in aesthetics as 
well as in physical excellence. The American idea is at present too 
closely connected with mere winning, and not enough with develop- 
ment. In the past the physical athlete has been too much associated 
with the pugilist, and has been looked down upon as having merely 
brute strength. The intellectual type, on the other hand, has been 
content wholly to neglect bodily development. 

In the last three years considerable evidence has accumulated to 
show that the sitting posture of the sedentary man tends sooner or 
later to produce nervous prostration, and that the ordinary chair 
invites to this effect by producing a bent attitude, both in the forward 
direction and in the shoulders. The effect of the former is to tax 
the splanchnic nerves and congest the portal circulation. The 
splanchnic area, which is enormous, is a sort of overflow tank for the 
blood. If the muscles of this area are allowed to relax through im- 
proper position in standing or sitting, the result is the stagnation 
of the blood in the abdomen, and this in turn results in a vicious 
circle of evil effects. Since much of our life is spent in chairs, this 
fact is of no small importance. Improperly made school chairs and 
unhygienic habits of sitting in them may start off millions of young 
lives with round shoulders, curved spines, and the later effects of 
portal congestion. 

Exercise of mind does not simply mean exercise of intellect. The 
emotions and the will are equaliy a part of a well-developed healthy 
man. Late in life Darwin had occasion to lament the fact that his 
emotional capacity had become cramped because he had exercised 

•See G. L. Dickinson: "The Greek View of Life," New York (McClure, 
Phillips), 1906, pp. 131-134. 



714 KEPORT OF NATIONAL CONSERVATION COMMISSION. 

his mind in his own branch of work to the exclusion of other things. 
Whatever our ideas of theology or religion are, it is true that we all 
ought to have a spiritual sense. Some men lack this spiritual sense 
and are incapable of understanding the spiritual experience of others. 
" For toil without purposeful and occupied leisure is unfilled pur- 
pose, a process arrested midway." a Worry and fear are unhealthy. 
Hope, courage, enjoyment, and an optimistic attitude generally are 
healthy. 6 

The ordinary workingman works two or three hours too much 
every day. Nearly every man overworks himself, takes insufficient 
rest and recreation, and worst of all, cuts off his normal portion of 
sleep. Fatigue ought to be " avoided like poison," because, physio- 
logically, it is really poison. Worry, fear, and anger also produce 
poisons harmful to the human body. This is suggested at least by 
the effect upon a nursing infant of violent paroxysms of anger, or 
periods of intense fear or anxiety on the part of its mother. The 
intense exhaustion which follows such paroxysms is another case in 
point. 

An animal lives a much more healthy life than the average man, 
because an animal follows instinct, while a man to a large extent 
endeavors to substitute for his instincts rules which are very often 
false. One of the instincts constantly disregarded by man is that 
which finds its expression in fatigue. The ordinary man working 
for some one else is compelled to toil beyond the fatigue limit; and, 
on the other hand, if a man is in business for himself, he does the 
same thing of his own will. Although no one knows what sleep is, 
it serves, according to the best theory, to eliminate poisons and to 
rebuild tissue. With rest is closely associated recreation. Play 
practices the power of a child's mind, while contest among children 
develops self-control. c Similarly, adults are rested by play or recrea- 
tion, their minds and bodies are relaxed, while their contests of mimic 
warfare develop their powers of will and effort. 

Section 7. — Sex hygiene. 

One element in personal hygiene concerns the sex relation. This 
can not be treated under other heads, for the sex relation is so purely 
a personal and individual one. From its normal utilization there is 
little to fear, but from the effects of illegitimate sexual practices the 
world suffers enormous yearly losses. It is hardly possible to have 
promiscuous sex relations out of wedlock without contracting one or 
the other of trie serious venereal diseases. The best authorities report 
that " every prostitute is diseased some of the time and some prosti- 
tutes are diseased all of the time." 

One disease, syphilis, infects the blood and therewith all parts of 
the body. For months after infection with this disease the indi- 

° Simon N. Patten : " The New Basis of Civilization/' New York (Macinillan), 
1907, p. 158. 

6 Du Bois : " The Psychic Treatment of Nervous Disorders," New York, 1905, 
465 pp. Saleeby: "Worry, the Disease of the Age," New York (Stokes), 1907. 
Sidis: "The Psychology of Suggestion," New York (Appleton), 1899, 386 pp. 
Schofield : " The Force of Mind, or the Mental Factor in Medicine," London 
(Churchill), 1902, 309 pp. 

c See President G. Stanley Hall : " Play and Dancing for Adolescents," Inde- 
pendent, reprinted in " Mind and Body," Vol. XIV, 1907, pp. 43-48, 



fisher.] NATIONAL VITALITY. 715 

vidual may communicate it by a kiss as well as by cohabitation ; and 
articles moistened by his secretions — towels, drinking glasses, pipes, 
etc. — may also convey the infection. While under proper treatment 
the disease is not always dangerous to life in the earlier years, yet 
the possibilities of transmitting the contagion should forbid marriage 
for at least three years. 

The most serious results of syphilis, some authorities say, may 
appear years after its acquisition, when the individual has been 
lulled into a false sense of security by long freedom from its mani- 
festations and considers himself cured. Many cases are practically 
incurable. Some are fatal in spite of treatment. It may attack any 
organ of the body. Among the many diseases to which it may lead 
are apoplexy, paralysis, insanity, and locomotor ataxia; and these 
often appear after the man has acquired a family that is dependent 
upon him for support. 

The leading insurance companies refuse to insure the life of a 
syphilitic person for four or five years after the disease was con- 
tracted, and then only upon special terms, for their records prove 
that syphilis shortens life. 

That the syphilitic parent may transmit the disease to his offspring 
is common knowledge. Some of his children are destroyed by the 
inherited disease before birth; others are born to a brief and sickly 
span of life; others attain maturity, seriously handicapped in the 
race of life by a burden of ill health, incapacity, and misery produced 
by the inherited taint, while still others escape these evil effects. 

Forel, in Die Sexuelle Frage, shows that even Weissmann does not 
deny the possibility of poisoning the germ cell and so transmitting 
some " acquired characteristics," as in alcoholism and venereal poison- 
ing. One of the saddest facts in both cases is that the parent may 
escape and the children reap the results in insanity, tendency to con- 
sumption, and prostitution. 

Another disease — 

Gonorrhea, while usually cured without apparent loss of health, has always 
serious possibilities; it kills about 1 in 200; it impairs the sexual power and 
fertility of a much larger number ; it often produces urethral strictures, which 
later may cause loss of life. 

The persistence of gonorrhea in the deeper parts long after it is outwardly 
cured leads to the unsuspected communication of the disease to women with 
whom the individual may cohabit. Much of the surgery performed upon women 
has been rendered necessary by gonorrhea contracted from the husband. Should 
she while infected with this disease give birth to a child, the baby's eyes may 
be attacked by the infection, sometimes with immediate loss of sight. Probably 
25 per cent 6 of the blindness of children is thus caused. 

Dr. Prince A. Morrow says : 

This social danger comes from frequent introductions of these diseases into 
marriage. The frequency of marital contamination does not admit of exact 
mathematical expression, as both social sentiment and professional ethics unite 
to cover up and conceal it. Possibly 10 per cent of men who marry infect their 
wives with venereal disease. 

° Circular No. 2, " Self-protection," Chicago Society of Social Hygiene, pp. 7-8. 

b " The average of a great many statistics shows that one-fourth of all blind 
persons owe their affliction to the effects of ophthalmia of the new born." Chas. 
H. May, M. D., ophthalmic and aural surgeon, New York, Transactions of Amer- 
ican Societies of Sanitary and Moral Prophylaxis, Vol. II, 1908. 

S. Doc. 419, 61-2—7 



716 REPORT OF NATIONAL CONSERVATION COMMISSION. 

The report of the Committee of Seven (New York) shows that in 
private practice nearly 30 per cent of venereally infected women were 
contaminated by their husbands. The report of the Committee on 
Sanitary and Moral Prophylaxis (Baltimore) shows that nearly 40 
per cent of the infections in women seen in private practice were com- 
municated in married life. " My own observations at the New York 
Hospital, extending over a period of several years, would indicate 
that fully 70 per cent of all women who came there for treatment of 
syphilis were respectable married women who had been infected by 
their husbands." a 

Observation shows that gonorrhea is markedly intensified in viru- 
lence and danger to the woman in fulfilling the functions for which 
marriage was instituted. Pregnancy and childbearing open the way 
for germs. One of the most constant effects of gonorrhea in women 
is permanent and irremediable sterility. Fifty per cent of gonor- 
rheally infected women become absolutely sterile, and a still larger 
percentage sterile after the first child is bprn (one-child sterility). 
Noeggerath found in 81 gonorrheal women 49 entirely sterile. In 80 
sterile marriages Kehrer found 45 caused by inflammatory changes of 
gonorrheal origin. It is estimated that the husband is directly re- 
sponsible for 20 to 25 per cent of sterility from his inability to pro- 
create as the result of gonorrhea. In addition the husband, though 
not sterile himself, may infect his wife, rendering her sterile. The 
disease is ultimately responsible for about 70 to 75 per cent of all 
sterility in married life, which is not of choice, but of incapacity. 
Lier-Ascher's careful statistics place this proportion at 71.2 per cent. 
These figures relate to absolute sterility. The chief social danger of 
gonorrhea as a depopulating factor is the creation of secondary steril- 
ity, or what has been expressively termed " one-child sterility." The 
large percentage of marriages in which one child represents the total 
fecundity of the family justifies the conclusion that this sterility is 
in many cases not of choice, but of procreative capacity extinguished 
by gonorrhea. 

In addition, the inflammation set up in the maternal organs may 
render the mother a permanent invalid or compel her to submit to a 
mutilating operation to save her life. 

Gynecologists furnish statistical evidence showing that 80 per cent 
of the deaths due to inflammatory diseases peculiar to women 6 and 
about 70 per cent c of all the work done by specialists for diseases of 
women is caused by gonorrhea. 

In addition to the effect of a low protein diet on endurance, already 
discussed, and on general health, its relation to the sexual Mfe should 
be mentioned. Experiments on this subject seem to show that exces- 
sive meat eating and excessive protein intake tend to irritate the 
sexual organs and to produce abnormal sexual desire just as they do 

° Morrow, Social Diseases and Marriage, Philadelphia (Lea), 1904. 

6 In report of special committee of the American Medical Association, 1901, 
Hunniston says : " Ninety per cent of inflammatory troubles of maternal organs 
are attributable to gonorrhea." Price says : " That in over 1,000 operations for 
pelvic trouble 95 per cent were attributable to this infection." Another author- 
ity gives a percentage of 75. 

c Address of Doctor Cleveland, president of American Gynecological Society, 
at National Congress of American Physicians and Surgeons, Washington, 1907* 



fisher.] NATIONAL VITALITY. 717 

a desire for alcoholic stimulation. This fact is of importance in pre* 
venting secret vice among the young. 

Thanks to the efforts of a few farsighted men like Dr. Prince A. 
Morrow, Prof. C. R. Henderson, and Mr. Edward Bok, these subjects 
are being given some of the publicity they deserve. Reticence on 
these subjects is justified only so far as it makes for youthful inno- 
cence. But ignorance is not innocence; on the contrary it is the 
surest road to guilt. 

Section 8. — Personal hygiene in general. 

Personal hygiene is only beginning to be generally exploited. Most 
persons leave their health to be attended to by physicians and health 
officers, just as many people leave their religion in the hands of a 
priest or clergyman. So far as practiced at all, personal hygiene has 
been confined chiefly to invalids and athletes. Even by them it is 
usually practiced to tide over an illness or to prepare for a contest. 
But it is manifest destiny that a wise economy of vitality will sooner 
or later be practiced. Waste of vital resources is as irrational as 
waste of natural resources. Neither is inexhaustible and both must be 
conserved. Thoughtlessness and ignorance are the reasons for the ap- 
palling waste of both now going on. Even people who do not defi- 
antly abuse their strength by definite excesses are liable to waste k 
gradually. Slightly unhygienic habits grow, and their effects are 
doubtless cumulative. It is well known that even a so-called " venti- 
lated house," if lived in long enough without sufficient outdoor life, 
may induce tuberculosis. This must be through the repetition of an 
infinitesimal injury produced through each respiration eighteen times 
a minute for twenty-four hours a day for half a lifetime. 

So with the use of food preservatives. Food manufacturers have 
laid much emphasis on the fact that preservatives are " harmless " 
because used in small quantities, but Doctor Wiley has raised the 
question whether even very small quantities of these preservatives, 
if used continuously for a sufficient length of time, are not injurious. 
The same applies to the repetition of preservatives in a large number 
of different foods. If only one particular food contained a preserva- 
tive, the effect would be relatively negligible; but as one food after 
another has become adulterated, the human stomach is made the daily 
receptacle of many times the " harmless " amount in any one par- 
ticular food. The obstacles to hygiene which have accumulated with 
civilization are almost as numerous and as small as the barnacles 
which impede a ship. To remove them is in large part to " return to 
nature." Many of the inventions of which civilization boasts have 
had an unhygienic side. The invention of houses has made it pos- 
sible for mankind to spread all over the globe, but it is responsible 
for tuberculosis, especially after glass was devised, which while let- 
ting in the light keeps out the air. The invention of cooking and 
preparing foods has widened the variety of man's diet, but has led to 
the decay of his teeth. The invention of the alphabet and printing 

a See Ottofy, " The Teetli of the Igorots," Dental Cosmos, July, 1008, where 
it is shown, statistically speaking, that the teeth of Americans are " ten times as 
bad as those of the Igorots," while the civilized Filipinos have teeth as bad as 
those of Americans. 



718 REPORT OF NATIONAL CONSERVATION COMMISSION. 

has made possible the accumulation of knowledge, but it has produced 
eye strain with all its attendant evils. The invention of chairs has 
added to human convenience, but has led to spinal curvature and 
abdominal congestion. The device of a division of labor has added 
to wealth, but has destroyed the normal balance of mental and phys- 
ical work, recreation, and rest. Similar fault may be found with 
clothing, especially corsets, shoes, and hats, and with numerous other 
contrivances. Yet it would be foolish, even if it were possible, to 
attempt to " return to nature " in the sense of abolishing civilization. 
We must not go backward, but forward. The cure for eye strain is 
not in disregarding the invention of reading, but in introducing the 
invention of glasses. The cure for tuberculosis is not in the destruc- 
tion of houses, but in devices for ventilation. It is a little knowledge 
that is dangerous. Civilization can, with fuller knowledge, bring its 
own cure and make the " kingdom of man " far larger, even in respect 
to hygienic conditions, than " nature " people can ever dream of. 

Unhygienic customs and fashions are exceedingly slow to yield, 
but they do yield in the end. It should be the part of intelligent men 
to lead in hygienic reform, not by intolerant and impatient abuse of 
their fellow-men, but by the quiet force of example. The intolerant 
and impatient reformer does incalculable harm, for he takes no ac- 
count of that subtle perversity of human nature which resents his 
interference. Equally harmful is the man who seeks only to imitate 
the crowd, who condones the vices of his time and country. 

But we must always bear in mind what has been called the " psy- 
chology of the crowd." Tarde, Le Bon, Baldwin, Ross, and others 
have shown that society is largely ruled by customs which grow out 
of imitation. In order that any social custom shall be changed, 
initiative is necessary. The upper classes should take the lead, for any 
reform will spread many times more quickly when the initiative comes 
from above than when it comes from below. Western civilization has 
made its marvelously rapid progress in Japan for the simple reason 
that the Mikado approved, and marvelously slow progress in China 
for the simple reason that the Empress disapproved. 

We find the same principle at work in the progress of medicine. 
Hydrotherapy originated with a peasant and required three centuries 
to come into vogue. The use of sour milk, on the other hand, has been 
advocated only during the last two or three years, but the initiative 
came from Metchnikoff, one of the foremost of medical scientists. 
The consequence is that the so-called " sour-milk craze " has already 
led to great industries and affected the business of groceries, soda- 
water fountains, and even liquor saloons. 

The change constituting hygienic reform will be brought about most 
rapidly by the influences on the young. If children in their homes 
and schools are given proper models for imitation, the public opinion 
which they will form may make a revolution in a single generation. 
Anyone who realizes the almost resistless force of the principle of 
imitation, especially when applied to children, will receive a new sense 
of the responsibility he takes in setting an example to the young. 
There are three classes in particular on whom the responsibility is 
heavy — teachers, physicians, and parents. If they wish the child to 
be free from the cigarette habit, they must sacrifice the cigar and pipe 
habit, even though it be true that cigars and pipes are not injurious to 
adults. They may believe this, but the children will not. The same 



fishhr.] NATIONAL VITALITY. 719 

Erinciple applies to other and more serious infractions of the laws of 
ealth. It is probably through the love of the next generation, rather 
than through any selfish care for the present, that men and women 
now living will take the most pains to secure the best results in 
bringing about the change in living conditions for which every 
Irygienist hopes. 

Chapter X. — Are hygienic measures eugenic? 

Section 1. — Prolongation of weak lives. 

We have discussed two factors which cooperate to produce vitality, 
namely, heredity and hygiene ; and two corresponding methods of im- 
proving vitality, namely, by utilizing a possible science of eugenics 
on the one hand and by utilizing the existing science of hygiene on 
the other. The question now arises, Are these two methods in conflict 
with each other ? It is charged that hygiene prolongs the lives of unfit 
and defective classes. We have already seen that in Indiana, institu- 
tional care of the insane has prolonged the average insane lifetime by 
some eight years. Referring to the insane, Dr. Charles Dana says : 

For twenty-five years the explanation of this increase in statistics of insanity 
has been that more cases were observed and more victims kept in institutions 
than formerly; and this is still the explanation. It is my opinion, however, 
that the increase is a real one, and it is one to be expected not only from the 
strenuousness of modern life and increase of city population, but also, because 
more feeble children are nursed to maturity and more invalid adolescents are 
kept alive to propagate weakly constitutions or to fall victims themselves to 
alienation, the period of life susceptible to insanity is longer. 

A fourth of the cases of insanity is due to so-called " moral causes : " Emo- 
tional strain, shocks, and vicious indulgences. But moral causes are not sufficient 
to cause insanity if the individual has a strong constitution. Insanity is increased 
in part, then, because we are saving too many lives by the careful regulations 
of our health boards. Hence, those who are working so enthusiastically and 
nobly and successfully in preventing disease achieve results which carry serious 
responsibilities for the State." 

It is true that we prolong the lives of the insane and defective 
classes, and that they thus make a greater burden on society. We 
should see to it that certain of these classes are not permitted to prop- 
agate their kind. This point has been explained in Chapter VI. 

It is further claimed that infant mortality is but the operation of 
natural selection and should not be interfered with if we are to keep 
up the vital power of the race. Preventive medicine has certainly 
prolonged the lives of infants or, at any rate, of children in general. 6 
But has this weakened the race ? It is pointed out that the mortality 
later in life has not decreased, and that in some cases it has even 
tended to increase. But this fact can be explained in either of two 
ways. One is on the hypothesis of the extension of the lives of weak 

a " Psychiatry in its relation to the other sciences," by Charles L. Dana, M. D., 
before the section on psychiatry at the International Congress of Arts and 
Science, at St. Louis, September, 1904. See also Janus in Modern Life, by W. M. 
Flinders Petri, New York (Putnam), 1907. 

6 See Edwin Graham, " Infant mortality," Journal American Medical Asso- 
ciation, September 26, 1908 ; also Edward B. Phelps, " Statistical study of infant 
mortality," Quarterly Publications American Statistical Association, September, 
1908. Mr. Phelps shows that infant mortality has declined less than is com- 
monly believed, and that its apparent decline is often due to inaccurate and 
misleading statistics. 



720 REPORT OF NATIONAL CONSERVATION COMMISSION. 

infants. The other is on the hypothesis of the comparative neglect 
of hygiene among adults. It is surprising that this latter alternative 
has not been given due consideration. 

Every detail of infant life has latterly been made the subject of 
special study, and every mother of common intelligence has tried to 
learn and to apply the results of that study. The times of the baby's 
meals, the quantity of its feeding, the modification and sterilization of 
cow's milk, the hours of sleep, the ventilation of sleeping rooms, and 
other innumerable details are now attended to with scrupulous care. 
The change in these respects, even within the memory of most persons 
now living, is striking. The children have reaped the reward. But 
no corresponding change has taken place in the habits of the adult 
population. Many families buy one grade of milk for the babies, 
and another cheaper grade for the rest of the family. This they re- 
gard as " economy." Parents require their children to keep regular 
and suitable hours for sleep, but " owl it " themselves. They will 
keep their children out of doors, and send them into the country, but 
subject themselves to the dust, smoke, and close air of the workroom 
and places of business. They will not allow their children to use 
alcohol or tobacco, or even tea or coffee, much less opium, chloral, or 
other habit-forming drugs, but they take these themselves as a matter 
of course. The}?- are now insisting on playgrounds for children, but 
their own amusements are sought in the unhygienic theater, or maybe 
in the saloon or immoral resort. The child is protected on all sides, 
with the result that he sometimes lives almost an ideal animal life, 
with its due proportion of amusement, exercise, rest, and sleep. The 
parents themselves are tied down to drudgery, overwork, worry, and 
long hours. The difference, when we reflect upon it, is startling. We 
make hygiene paramount for our children; for ourselves we neglect 
it totally, partly from the idea of sacrificing ourselves for the sake of 
our children, partly from necessity, real or imagined, and partly 
from the thraldom of habit already formed. With such a contrast 
between the recent improvement of hygiene in childhood and the lack 
of improvement in middle life, one need not wonder that the mor- 
tality of one period has improved and that of the other has not. We 
do not need to invoke the aid of the theory that weak lives have been 
more prolonged than strong lives. The moral is that Irygiene should 
not stop in childhood. It is natural and proper, however, that the 
first attempt to apply hygienic knowledge should begin with children. 
It is through children that new ideas usually make their way into 
custom. " You can't teach an old dog new tricks." Grown persons 
have habits already formed, and when once a habit is formed it is 
difficult to change it. 

Habits of living among adults have even grown worse in some 
respects. Observing practitioners comment on the increasing nervous 
tension in modern life. The rush of the railway train, the telephone, 
the elevator are at once an outgrowth and an excitant of this in- 
creased tension. They are life's pace makers, and the pace is ever 
quickened. The health officer of New York City attributes to this 
severer strain the increase of heart and nervous diseases. It would 
be interesting to know the relative prevalence of adult diseases under 
conditions of reposeful and exciting surroundings and occupations, 
but I know of no investigation on this phase of the subject. 



fisher.] NATIONAL VITALITY. 721 

While this report was being written the recent figures from Great 
Britain came to hand. They show that the tendency of the death 
rates among the later ages to increase seems to have given place to a 
slightly opposite tendency. The expectation of life at ages 40, 60, 
and 80 during the decade of 1891-1900 has a little more than held 
its own as compared with the previous decade. 

Section 2. — Children's diseases impair both fit and unfit. 

Another point needs emphasis. When it is said that the lives of 
weak infants are prolonged it is commonly overlooked that the same 
causes also prolong the lives of the strong, and, reversely, that un- 
hygienic conditions which tend to exterminate the weak tend also 
to shorten the lives of the strong. Bad hygiene is merely a common 
handicap for all classes. The burden of proof is upon those who 
claim that it has a differential effect and increases the process of 
weeding out the unfit. This weeding-out process goes on whether 
there is a great or a small obstruction to overcome. Bad air and 
children's epidemics are the common environment of all. While 
this must produce a greater mortality, it remains to be shown that it 
would be more selective. 

That a high infant mortality does not tend to lengthen life, but 
rather to stunt all life, would seem to be indicated by the evidence, 
so far as it can be interpreted. Russia, for instance, has a high 
infant mortality. If the statistics are to be trusted, it is 70 per cent 
greater than in the United States; yet Moscow and St. Petersburg 
have a general mortality rate which greatly exceeds that of similar 
cities in this country. 

It may be that the more unfavorable the struggle for existence 
the more rapidly will natural selection result in improved vitality. 
But even if this were true, it would not imply that in a more favor- 
able environment selection would cease. And it may not be true. It 
may be that adversity, if too severe, will crush and injure the sur- 
vivor as well as eliminate the unfit. We do not look for the best 
trees on the bleak mountain top, but in the genial valley. As we go 
up the struggle for existence increases, until even the sturdiest fail 
to thrive above the " timber line." 

The farmer who tries to improve his stock does not select hardships. Cold 
and starvation are now negligible quantities in the great ranches, and the breeds 
that were notable for ability to withstand them give way to varieties that may 
be adapted to neither emergency." 

Venereal diseases, hook-worm disease, malaria, and many other 
maladies shorten and weaken life, whether of weak or strong. Re- 
ferring to the racial degeneration probably caused by malaria on the 
sturdy Greek, Maj. Ronald Ross said y in an address before the Oxford 
Medical Society, November 29, 1906 : & 

Now what must be the effect of this ubiquitous and everlasting incubus of 
disease on the people of modern Greece? Remember that the malady is essen- 
tially one of infancy among the native population. Infecting the child one or 
two years after birth, it persecutes him until puberty with a long succession of 
febrile attacks. * * * Imagine the effect it would produce upon our own 

. o Simon N. Patten, The New Basis of Civilization, New York (Macmillan), 
1907. 

B This quotation is from Dr. L. O. Howard's report to the Conservation Com- 
mission on " Economic loss to the people of the United States through insects 
that carry disease." 



722 EEPOKT OF NATIONAL CONSERVATION COMMISSION. 

children here in Britain. * * * What would be the effect upon our popula- 
tion, especially our rural population — upon their numbers and upon the health 
and vigor of the survivor? It must be enormous in Greece. People often seem 
to think that such a plague strengthens a race by killing off the weaker individ- 
uals; but this view rests upon the unproven assumption that it is really the 
weaker children which can not survive. On the contrary, experience seems to 
show that it is the stronger blood which suffers most — the fair, northern blood 
which nature attempts constantly to pour into the southern lands. If this be 
true, the effect of malaria will be constantly to resist the invigorating influx 
which nature has provided; and there are many facts in the history of India, 
Italy, and Africa which could be brought forward in support of this hypothesis. 
* * * In prehistoric times Greece was certainly peopled by successive waves 
of Aryan invaders from the north. * * * That race reached its climax of 
development at the time of Pericles. * * * Suddenly, however, a blight fell 
over all. Was it due to internecine conflict or to foreign conquest? Scarcely, 
for history shows that war burns and ravages, but does not annihilate. Thebes 
was thrice destroyed, but thrice rebuilt. Or was it due to some cause, entering 
furtively and gradually sapping away the energies of the race by attacking the 
rural population, by slaying the newborn infant, by seizing the rising genera- 
tion, and especially by killing out the fair-haired descendant of the original 
settlers, leaving behind chiefly the more immunized and darker children of their 
captives, won by the sword from Asia and Africa? * * * I can not imagine 
Lake Kopais, in its present highly malarious condition, to have been thickly 
peopled by a vigorous race; nor, on looking at those wonderful figured tomb- 
stones at Athens, can I imagine that the healthy and powerful people repre- 
sented upon them could have ever passed through the anaemic and " splenomega- 
lous " infancy (to coin a word) caused by widespread malaria. Well, I venture 
only to suggest the hypothesis, and must leave it to scholars for confirmation 
or rejection. Of one thing I am confident — that causes such as malaria, dysen- 
tery, and intestinal entozoa must have modified history to a much greater extent 
than we conceive. 

Evolution in human society is a wonderfully complex thing. Sur- 
vival of the races has long been dependent on a long period of pro- 
tection of children by parents, and may in future even depend on 
protection of other kinds. 6 

Section 3. — Fitness is relative to environment. 

Whether or not degeneration is actually going on is a question for 
which the data are insufficient for us to form an intelligent generaliza- 
tion. That there are very strong forces working in that direction can 
not be questioned, but there are also very strong forces working in 
the opposite direction. In discussing degeneration, one point must 
be borne in mind which has often been forgotten by writers on the 
subject. Man's fitness to live is relative to the environment in which 
he is to live. If muscular strength decreases, it is not a sign of de- 
generation, provided muscular strength is no longer needed. One 
does not speak of hothouse grapes as degenerates. They doubtless 
lack the hardy characteristics of wild grapes, but these characteristics 
are not needed in a hothouse. • 

If it should prove true that in some directions humanitarian im- 
pulses betray us into favoring the survival of the unfit and their 
perpetuation in the next generation, such shortsighted kindness must 
be checked. But all the dangers of perpetuating vital weaknesses can 
be avoided if proper health ideals are maintained. For when such 

° Physicians maintain that some diseases, especially typhoid fever and pneu- 
monia, are more apt to attack the strong than the weak. 

6 See Prince Kuropatkin, " Mutual Aid a factor in Evolution," New York 
(McClure-Phillips), 1902. 



fisher.] NATIONAL VITALITY. 723 

health ideals become a national possession fewer weak infants will 
be born into the world. This will come about in three ways : First, 
marriage and " sterilization " laws will reduce the number of mar- 
riages of degenerates. Secondly, parents will be more careful of 
transmitting disease or weakness to their offspring. There is strong 
reason to believe that inheritance depends largely upon the physical 
condition of both parents at the time of conception. If at such a time 
either parent, or both parents, are in a state of intoxication or suf- 
ferers from venereal disease, this lack of hygiene on their part will 
affect the heredity of the offspring. Immorality, which practically 
means lack of sex hygiene, never strengthened a race ; on the contrary 
it has been the most potent cause of race extinction (of the Hawaiians, 
Indians, negroes, and others). Thirdly, the influence of higher 
ideals of health and vitality will tend both to restore the attraction 
of a strong and beautiful physique to its rightful place among the 
various attractions which lead to marriage, and to lessen the allure- 
ments of such extraneous attractions as wealth. 

° See F. L. Hoffman, " Race Traits and Tendencies of the American Negro," 
Publication of American Economic Association, Ch. VII. August, 1896. 



Part IV.— RESULTS OF CONSERVING LIFE. 

Chapter XI. — Prolongation of life. 

Section 1. — Life is lengthening. 

We have already seen evidence of the possibility of prolonging 
life : In Europe the life span is double what it is in India. The death 
rate of Dublin is over twice that of Amsterdam, and three times that 
of rural Michigan. Again, making every allowance for inaccuracies of 
old records, we have strong reason to believe that life is twice as long 
as three or four centuries ago, and modern accurate records show that 
it is to-day increasing more rapidly than ever. The rate at which 
this lengthening proceeds per century is shown in the following 
table, based on Chapter I. 

Rate of lengthening life (in years, per century). 



Country. 



Periods. 



Males. 



Females. 



England 

Do 

France 

Prussia 

Denmark 

Sweden 

United States: 

Massachusetts . 

Do 

India 



1838-1854 to 1871-1881, or 30 years 
1871-1881 to 1891-1900, or 20 vears 
1817-1831 to 1898-1903, or 76 years 
1867-1877 to 1891-1900, or 23 years 
1835-1844 to 1895-1900, or 57 vears 
1816-1840 to 1891-1900, or 67 years 

1789 to 1855, or 66 years 

1855 to 1893-1897. or 40 years 

1881 to 1901, or 20 years 



5 
14 

10 
25 
13 
17 



7 

14 





9 

16 
11 
29 
15 
15 



From this table we observe : 

First. That the rate of progress is extremely variable in different 
countries. It is perhaps no accident that the maximum rate obtains 
in Prussia, which is probably the most progressive country in the 
discovery and application of scientific medicine. If progress con- 
tinues for a century at merely the present rate, human life in Prus- 
sia will be twenty-five to twenty-nine years longer than at present. 
The average rate of improvement for all the countries, excepting 
India, is about fifteen years per century. 

Second. It is noticeable that in practically all cases the improve- 
ment is more among females than males. This is one expression of 
the progress which womankind is now making in all lands. 

Third. This table, as well as the estimate of Professor Finkelnburg 
already quoted, shows that not only is the average duration of human 
life increasing, but that the rate of increase is also increasing. The 
estimate of Finkelnburg that the lengthening of life during the inter- 
val between the sixteenth century and the end of the eighteenth cen- 
tury was from eighteen or twenty years to a little over thirty years 
shows a rate of increase of about four years per century. During 

724 



iris her.] NATIONAL VITALITY. 725 

the following century he estimated that the life span increased from 
a little over thirty to thirty-eight or forty years, or about nine 
years per century. In the table we see that in England the length of 
life was increasing in the middle of the nineteenth century at a rate 
of from five to nine years per century, while during the last quarter 
it was increasing at from fourteen to sixteen years per century. In 
Massachusetts the imperfect data indicate that life lengthened in the 
first half of the eighteenth century at the rate of about seven years a 
century. The indication for the last part of the nineteenth century 
is that it increased at the rate of fourteen years per century. 

We may briefly summarize chronologically the general rate of 
increase as follows: 

Lengthening of human life per century. 

Tears. 

During seventeenth and eighteenth centuries 4 

During first three quarters of the nineteenth century 9 

Present rate in Massachusetts 14 

Present rate in Europe 17 

Present rate in Prussia 27 

Section 2. — Table showing further practicable prolongation. 

It would be surprising if the future should not witness a further 
lengthening of human life, and at an increasing rate. Of course 
there is a limit to the further increase of human life, but there is 
good reason to believe that the limit is still far off. 

The following table shows that at least fourteen years could be 
added to human life by the partial elimination of preventable diseases 
according to the stated ratios of preventability. This is equivalent 
to a reduction in the death rate of about 25 per cent. The table is 
based on the causes of death given in the census volume for mortality 
statistics for 1906. These causes are arranged according to the aver- 
age, or rather median, 6 age at death from the disease. This median 
age is given in the second column. The order in this column shows at 
a glance the successive onslaught of, or rather fatality from, the vari- 
ous causes of death. The table shows the successive bombardments of 
disease to which human life is subject. 

The third column gives the average lost " expectation of life ; " c 
that is, the expectation cut off by each particular cause of death. 

The fourth column represents the percentage which the deaths from 
each particular cause bear to the total number of deaths in 1906 in 
the registration area. It shows the relative importance of the differ- 
ent causes of death in the present death rate, but has no reference to 
the age at death. 

The fifth column contains an estimate, made by physicians, of the 
ratio of preventability of deaths from each cause named. 

°For detailed statement in regard to the construction of this table, see appen- 
dix to this chapter. 

6 By the " median " age at death is meant the age such that one-half of the 
deaths occur earlier and one-half later than this age. The " median " is a species 
of average, but differs from the ordinary arithmetical average. It has the great 
advantage of ease of computation. 

c The " expectation " is taken from the figures of Abbott for Massachusetts, 
1893-1897, and is the average of expectation of males and females. See Report 
State Board of Health for Massachusetts, 1898. 



726 



REPORT OF NATIONAL. CONSERVATION COMMISSION. 



The items in the sixth column are found by multiplying together 
those in the fourth and fifth columns, and express the percentage which 
the preventable deaths from each cause named bears to the total num- 
ber of deaths from all causes. 

The seventh and last column gives the figures for which the table 
is constructed, namely, the amount of prolongation of life which 
would come about through preventing deaths according to the ratios 
of preventability in column 5. When it is said that a death is pre- 
ventable, it is not, of course, meant that the person saved from it 
will never die, but merely that his death is postponed. The term 
" postponable " would avoid a great deal of confusion on the subject. 

The principle on which the last column is constructed is simply 
the principle of averages. The column shows the prolongation of 
life which would be caused by postponing the " postponable " deaths 
by the amounts indicated in column 3. To illustrate this princi- 
ple, suppose ten magnitudes to be averaged arithmetically, and that 
their average is thirty. To fix our ideas, we may suppose these ten 
magnitudes to be represented by ten lines drawn on a sheet of paper. 
It is evident that if one of these ten lines is prolonged the average 
of the ten will be thereby increased by exactly one-tenth of the pro- 
longation of that one line. 

Possible prolongation of life. 



(i) 



Cause of death. 



1. Premature birth 

2. Congenital malformation of 

heart (cyanosis) 

3. Congenital malformations 

other than of heart 

4. Congenital debility 

6. Hydrocephalus 

6. Venereal diseases 

7. Diarrhea and enteritis 

8. Measles 

9. Acute bronchitis 

10. Broncho-pneumonia 

11. Whooping cough 

12. Croup 

13. Meningitis 

14. Diseases of larynx other than 

laryngitis 

15. Laryngitis 

16. Diphtheria 

17. Scarlet fever 

18. Diseases of lymphatics 

19. Tonsilitis 

20. Tetanus 

21. Tuberculosis other than of 

lungs 

22. Abscess 

23. Appendicitis 

24. Typhoid fever 

25. Puerperal convulsions 



(2) 
A. 



Median 

age of 

deaths 

from 

causes 

named. 



Years. 



23 

24 
24 
26 
28 



(3) 
B. 



Expecta- 
tion of 
life at 

median 
age. 



Years. 
50 

50 

50 
50 
50 
50 
50 
50 
50 
50 
50 
54 
54 

54 
54 
54 
54 
54 
52 
52 

40 
39 
39 
38 
« 37 



b(4) 



Deaths 
due to 
cause 
named as 
percent- 
age of all 
deaths. 



Per cent. 
2 

.55 

.3 

2.3 

.1 

.3 

7.74 
.8 

1.1 

2.4 
.9 
.3 

1.6 

.07 
.06 
1.4 
.5 
.01 
.05 
.19 

.17 
.08 
.7 
2 
.2 



(5) 

D. 
Ratio of 
preventa- 
bility (post- 
ponability),! 
e., ratio of 
"preventa-i 
ble" deaths' 
from cause 
named to 
all deaths 
from cause 
named. 



Per cent. 
40 




40 


70 
60 
40 
30 
50 
-10 
75 
70 

40 
40 
70 
50 
20 
45 
80 

75 
60 
50 
85 
30 



(6) 
E=CD. 



Ratio of 
"preventa- 
ble" denths 
from cause 
named to 
all deaths 
from all 
causes. 



Per cent. 
0.8 



.92 



.21 

4.64 

.32 

.33 

1.2 

.36 

.22 

1.12 

.03 

.02 

.98 

.25 

.002 

.02 

.15 

.13 
.05 
.35 
1.7 
.06 



(7) 

F=BE. 

Years 
added to 
average 
lifetime if 
deaths were 
prevented 
in the ratio 
of prevent- 
ability of 
column 5. 



Years. 
0.4 



.46 



.11 
2.32 
.16 
.17 
.6 
.18 
.12 
.6 

.02 

.01 

.63 

.14 

.001 

.01 

.08 

.05 
.02 
.14 
.65 
.02 



■ " Expectation " for females. 

•As to some inaccuracies in this column, see Appendix to this chapter, section 4. 



FISHER.] 



NATIONAL. VITALITY. 

Possible prolongation of life — Continued. 



727 



a) 



Cause of death. 



(2) 
A. 



Median 
age of 
deaths 
from 
causes 
named. 



(3) 



Expecta- 
tion of 
life at 
median 
age. 



(4) 
C. 



Deaths 
due to 
cause 
named as 
percent- 
age of all 
deaths. 



(5) 

D. 

Ratio of 
preventa- 
bility(post- 
ponability), 
i.e., ratio of 
"preventa- 
ble" deaths 
from cause 

named to 
all deaths 
from cause 

named. 



(6) 
E=CD. 



Ratio of 
"preventa- 
ble" deaths 
from cause 
named to 
all deaths 
from all 
causes. 



(7) 
F~BE. 

Years 

added to 

average 

lifetime if 

deathswere 

prevented 

in the ratio 

of prevent- 

ability of 

column 5. 



26. Puerperal septicemia 

27. Other causes incident to child- 

birth 

28. Diseases of tubes 

29. Peritonitis 

80. Smallpox 

31. Tuberculosis of lungs 

32. Violence 

33. Malarial fever 

34. Septicemia 

85. Epilepsy 

36. General, ill defined, and un- 
known catises (including 
"heart failure," "dropsy," 
and "convulsions") 

87. Erysipelas . . *. 

38. Pneumonia (lobar and un- 

qualified) 

39. Acute nephritis. 

40. Pleurisy 

41. Acute yellow atrophy of liver.. 

42. Obstruction of intestines 

43. Alcoholism 

44. Hemorrhage of lungs 

45. Diseases of thyroid body 

46. Ovarian tumor 

47. Uterine tumor 

48. Rheumatism 

49. Gangrene of lungs 

50. Anemia, leukemia 

61. Chronic poisonings 

62. Congestion of lungs 

53. Ulcer of stomach 

54. Carbuncle 

55. Pericarditis 

56. Cancer of female genital organs 

57. Dysentery 

58. Gastritis 

69. Cholera nostras 

60. Cirrhosis of liver 

61. General paralysis of insane 

62. Hydatid tumors of liver 

63. Endocarditis 

64. Locomotor ataxia 

65. Diseases of veins 

66. Cancer of breast 

67. Diabetes 

68. Biliary calculi 

69. Hernia 

70. Cancer not specified 

71. Tumor 

72. Bright's disease 

73. Embolism and thrombosis 

74. Cancer of intestines 

75. Cancer of stomach and liver... 

76. Calculi of urinary tract 

77. Cancer of mouth. 

78. Heart disease 

79. Influenza 

80. Asthma and emphysema 

81. Angina pectoris 

82. Apoplexy 

83. Cancer of skin 

84. Chronic bronchitis 

86. Paralysis 



Years. 
28 

31 
31 
31 
32 
33 
34 
34 
34 
35 



35 

37 

37 
39 
42 
42 
43 
44 
45 
46 
46 
46 
47 
48 
48 
48 
49 
49 
49 
52 
52 
52 
53 
53 
54 
55 
55 
56 
56 
57 
58 
58 
58 
59 
59 
59 
59 
60 
60 
61 
61 
63 
63 
64 
64 
65 
67 
70 
71 
71 



Years. 
a 37 

«35 
a 35 
34 
34 
33 
32 
32 
32 
32 



81 
30 

30 
29 
27 
27 
26 
25 
25 
24 

a 25 

a 25 
23 
23 
23 
23 
22 
22 
22 
20 

«21 
20 
19 
19 
19 
18 
18 
17 
17 
17 

al7 
16 
16 
16 
16 
16 
16 
15 
15 
14 
14 
13 
13 
13 
13 
12 
11 
10 
9 
9 



Per cent. 
0.4 

.36 
.1 
.5 
.01 
9.9 
7.5 
.2 
.3 
.29 



9.2 
.3 



.6 

.27 

.02 

.6 

.4 

.1 

.02 

.07 

.1 

.5 

.03 

.4 

.05 

.4 

.2 

.03 

.1 

.6 

.5 

.65 

.09 

.9 

.3 

.002 

.8 

.17 

.04 

.4 

.8 

.17 

.27 

.9 

.08 

5.6 
.26 
.6 

1.7 
.03 
.1 

8.1 
.7 
.23 
.4 

4.4 
.2 
.8 

1 



Per cent. 
85 

50 
65 
55 
75 
75 
35 
80 
40 




30 
60 

45 
30 
55 


25 
85 
80 
10 


60 
10 


50 
70 
50 
50 
50 
10 


80 
50 
50 
60 
75 
75 
25 
35 
40 


10 
40 
70 




40 






10 


25 
50 
30 
25 
35 


30 
60 



Per cent. 
0.34 

.18 
.06 
.28 
.01 
7.42 
2.7 
.16 
.12 



2.75 

.18 

3.15 
.18 

.15 



.2 

.03 

.2 

.1 

.015 

.01 



.4 

.32 

.05 

.54 

.22 

.002 

.2 

,06 

.02 



.08 
.07 
.19 



2.24 



.003 



2.02 
.35 
.07 
.1 

1.54 



Years. 
0.13 

.06 
.02 
.1 

.003 
2.45 
.86 
.05 
.04 



,85 
,05 

,94 
,05 
,04 



.15 


.04 


.34 


.09 


.08 


.02 


.002 


.0005 


.06 


.02 


.05 


.01 



.05 

.007 

.04 

.02 

.003 

.002 



,08 

,06 

,01 

.1 

.04 

.0003 

.03 

.01 

.003 



.01 
.01 
.03 



.36 



. 0004 



.26 

.05 

,009 

.01 

,17 



.24 
.5 



.02 
,04 



• " Expectation " for females. 



728 BEPOET OF NATIONAL CONSERVATION COMMISSION. 

Possible prolongation of life — Continued. 



(1) 


(2) 


(3) 


(4) 


(5) 


(6) 


(7) 


Cause of death. 


A. 

Median 
age of 
deaths 
from 
causes 
named. 


B. 

Expecta- 
tion of 
life at 
median 
age. 


C. 

Deaths 
due to 
cause 
named as 
percent- 
age of all 
deaths. 


D. 

Ratio of 
preventa- 
bility (post- 
ponability), 
i.e., ratio of 
" preventa- 
ble" deaths 
from cause 
named to 
all deaths 
from cause 
named. 


E=CD. 

Ratio of 
"preventa- 
ble" deaths 
from cause 
named to 
all deaths 
from all 
causes. 


F=BE. 

Years 

added to 

average 

lifetime if 

deaths were 

prevented 

in theaatio 

of prevent- 

ability of 

column 5. 


86. Softening of brain... 


Years. 
71 
73 
74 
74 
83 


Years. 
9 
9 
8 
8 
5 


Per cent. 
0.2 
0.83 
0.2 
0.25 
2 


Per cent. 


10 
45 
60 




Per cent. 


Years. 




0.08 
0.09 
0.15 


007 


88. Diseases of bladder 


007 


89. Gangrene 


01 


90. Old age 










All causes 


38 




100 


42.3 


o42.3 


14 06 








k£sum£. 














Diseases of infancy (having me- 
dian age 1) 






18.5 
4.2 
43 
34.3 


47 
67 
49 

28 


8.8 

2.8 

2]»2 

9.5 


4.4 


Diseases of childhood (having me- 
dian age 2 to 8) 






1.51 


Diseases of middle age ( having me- 
dian age 23 to 49) 






6.82 


Diseases of late life (having me- 
dian age 52 to 83) 






1.33 










All causes 






100 


42.3 


42.3 


14.06 











"Although this is the ratio of general preventability of deaths under existing con- 
ditions, the death rate, i. e., deaths in relation to population, will not in the end be 
affected in this ratio but by only about 25 per cent. The reason for this paradox is that 
deaths prevented lead to a larger population (See appendix to this chapter, section 3). 

Similarly, if of the ten lines three are prolonged each a certain 
stated amount, or are prolonged that amount on the average, the 
average of the whole ten will be increased by three-tenths of this 
amount. Consequently, if the saved lives from typhoid fever (No. 
24 in the table) are, on an average, prolonged thirty-eight years, and 
these saved lives represent 1.7 per cent of all lives, the average life will 
be prolonged by 1.7 per cent of thirty-eight years. This is 0.65 or 
two-thirds of a year. 

All the calculations are on the assumption of expectations of life, 
such that the saved lives will die according to the present law of 
mortality. Consequently, if the table should be corrected by sub- 
stituting in each case such an expectation of life as would conform 
to the improved mortality, the result would be an addition (2.1 
years) to the estimate of possible prolongation, which would there- 
fore become 16.2 years. The resume of the table shows that of 
the 14 years of possible prolongation of life 4.4 would be caused 
by reducing infant deaths under or near 1 year, 1.51 by reducing 
mortality from children's diseases, 6.82 from reducing the diseases 
of middle life, especially tuberculosis and typhoid, and only 1.33 
by reducing the mortality of diseases the deaths from which usually 
come after 50 years of age. 

• Best estimated graphically, as shown in appendix to this chapter. 



A 



loo 000 



So ooo 



So ooo 



7O000 



bO 000 



5oooo 



4oooo 



30000 



2oooo 



10 000 



\0 20 30 40 50 60 70 80 90 IooYeaRS 



9oooo 



80000 



JO 000 




SURVIVORSHIP CURVES, SHOWING SAFE MINIMUM IMPROVEMENT ATTAINABLE. 



fisheb.] NATIONAL VITALITY. 729 

The table shows that seven of the 90 causes of death are responsible 
for over half of the shortening of life, namely, diarrhea and enteritis 
(No. 7), broncho-pneumonia (No. 10), meningitis (No. 13), typhoid 
(No. 24), tuberculosis of lungs (No. 31), violence (No. 32), and 
pneumonia (No. 38). These alone shorten life needlessly by more 
than eight years. Against these seven causes, therefore, our special 
efforts should be directed. Pure milk, pure water, pure air, and 
reasonable protection from accident are the chief means known at 
present. When the public makes up its mind no longer to endure 
impure milk, impure water, and impure air, and unreasonable dan- 
gers to life and limb, life will lengthen eight years, and probably a 
great deal more. 

In the resume of the table columns 4, 6, and 7 are found from the 
original table by simple addition. Each figure in the fifth column is 
found by dividing the figure in the sixth by that in the fourth. 

The final figure in this column, 42.3, is the same as the sum of 
column 6, and means that according to medical opinion 42.3 per cent 
of the deaths which occur under present conditions are preventable 
(postponable). The death rate, however, will ultimately be reduced, 
not in this proportion, but by about 25 per cent, 6 while the average 
duration of life will be increased about 33J per cent. 

Section 3. — Diagram showing effect of prolongation at different ages. 

The whole process is best seen by means of a survivorship table, 
a diagram of which will be found on the next page. 

We have here four curves which represent the survivors m suc- 
cessive years from a hypothetical and representative list of 100,000 
persons born. The two of these curves which should be noted are 
the inner two, namely, those labeled "Mass. 1893-97 " and " Pos- 
sible I." The former is taken, in lieu of any better statistics, as 
representing the existing law of mortality in the United States. The 
latter shows what the law of mortality would be if the ratios of pre- 
ventability given in the preceding table were put in force. The 
curve Possible I is constructed on the supposition that all the deaths 
prevented or postponed subsequently occur according to the present 
law of mortality ; that is, that expressed in the curve Mass. 1893-97. 

The two remaining, or outer, curves are given merely for com- 
parison. The lowest, marked u Mass. 1855," shows the mortality 
which held true in Massachusetts in that year according to the 
estimates of the actuary, E. B. Elliott. The difference between this 
curve and the one above shows the number of years of life actually 
saved to 100,000 persons subject to the mortality of 1893-1897 instead 
of the mortality of 1855. The upper curve (Possible II) shows the 
modification in Possible I on the assumption that the saved lives, 
instead of following the present law of mortality (Massachusetts, 

a The result is in each case a weighted average of the individual ratios of 
preventability for the individual causes of death. 

6 See appendix. 

c See Proceedings of the American Association for the Advancement of 
Science, 1857, pp. 61, 69; also Sixteenth Registration Report, Massachusetts, 
1857, p. 204. 



730 EEPOET OF NATIONAL CONSERVATION COMMISSION. 

1893-1897), follow the law of mortality represented in the curve 
Possible II itself. 

This diagram shows at a glance what improvement has been made 
in mortality and at what ages, and what improvement is still pos- 
sible, and at what ages, according to the preventability known to be 
easily possible. We see that the curve, Possible I, does not drop as 
far in the first year of life as the curve Mass. 1893-97. This is 
because of the great saving of infant lives known to be possible. The 
years of life which would be saved to the 100,000 persons by the 
new hygiene are represented by the difference in area between the new 
curve AB"C"D and the old curve AB'C'D, from which it was con- 
structed by applying the ratio of preventability. This area can 
easily be measured by a planimeter, and is found to be 1,280,000, 
which, divided by the 100,000 persons, means an average addition of 
12.8 years to the lifetime of each person born. This result differs 
somewhat from the arithmetical calculation, 14.06, given in the pre- 
ceding table. 6 If the upper curve be used, which assumes that the 
" saved " lives die not according to the old but the new mortality, 
the addition becomes not 12.8 but 14.9 years, as against the 16.1 
computed arithmetically. We may hereafter refer to this minimum 
estimate of possible increase of life as, in round numbers, 15 years. 
The lengthening of life would be from 45 to 60, or one-third. 

The diagram also shows the saving of life which actually took 
place between 1855 and the period 1893-1897. The area between the 
curves for these two periods shows that 550,000 years were saved for 
a supposed group of 100,000 persons, or 5.5 per person. The whole 
area of the new curve AB"C"D is 5,810,000, or 58.1 years per person, 
which is the new average duration of life, as compared with 45.3 for 
1893-97 and 39.8 years for 1855. We may divide the diagram by 
two vertical lines drawn at the ages 17J and 60 in order to discover 
what part of the added life occurs between these ages — that is, within 
the working period — and what parts fall on either side. The addi- 
tion of 12.8 years to the lifetime of each of 100,000 persons, or 
1,280,000 years of life in all, is divided into three groups, namely, the 
years falling in the period of preparation, 200,000; in the working 

a The method of constructing the curves Possible I and Possible II from the 
curve Mass. 1893-97 is by means of the ratios of preventability given in the 
resume of the preceding table. See appendix. 

6 The discrepancy, 1.3 years, is due to the fact that in constructing the table, 
based on individual diseases, I was compelled to use for the percentages of 
deaths by ages (column 4) the percentages obtaining in the calendar year 1906; 
whereas the diagram is based on the idea of a stationary population, the dis- 
tribution of the deaths being represented by the shape of the curve Mass. 
1893-97. The diagramatic method is therefore more correct. The abnormal 
age distribution in 1906 results in making some of the figures in the last column 
of the table too large and some too small. In a general way, the figures for 
the earlier ages are too large and for the later ages too small, although the 
figures which are most too large are probably for ages 30 to 35. Consequently 
the greatest error in excess is for tuberculosis, which is possibly three-fourths 
of a year too large. No exact corrections are possible, and any systematic 
corrections, even inexact, would be very laborious. This would correspond to 
the elaborate actuarial calculations of Hayward in England and Glover in 
the United States. See Hayward " On the Construction of Life Tables and on 
Their Application, etc." Haydock and J. W. Glover, "A Study of Tuberculosis 
in the United States," Journal of Michigan State Medical Society, February, 
1909. 



FISHER.] 



NATIONAL. VITALITY. 



731 



period, 680,000; in the period of decline, 400,000. The following 
table will show the whole process: 





Preparatory 

period (ages 

0-171). 


Working pe- 
riod of life 
(17^-60). 


Period of de- 
cline (60 and 
beyond). 


Total. 




Years 
of life. 


Per 

cent of 
total. 


Years. 


Per 

cent. 


Years. 


Per 

cent. 


Years. 


Per 

cent. 


Mass. 1855. 


12.6 
13.5 
15.4 


32 
30 

26 


21.9 

25.0 
31.8 


55 
55 
55 


5.3 

6.8 

10.9 


13 
15 
19 


39.8 
45.3 
58.1 


100 


Mass. 1893-97 


100 


Possible I 


100 







These figures show that in 1855 the average person born lived only 
12.6 years of the 17J years in the period of preparation for life. In 
1893-97 he lived 13.5 years. If modern hygiene were applied accord- 
ing to the ratios of the assigned prevent ability, the figure would then 
be 15.4 years actually lived out of the 17^. Of the working period of 
42J years (17-J-60, the average man living under the mortality of 
1855 had only about half, or 21.9 years; under the mortality of 
1893-97 he had 25.0. and under the " Possible I " mortality he would 
have 31.8 years. 

In percentage the years in the working period remain 55 per cent 
of the total life in all cases. This assumes that with the prolongation 
of life the limits of the working period remain 17^ and 60. Since 
the prolongation of life carries with it a postponement of the age of 
disability, it follows that the proportion of working life would 
actually increase.® 

It will be seen in comparing the curves on the diagram that the 
change wrought in the character of the mortality curve by the new 
hygiene simply continues the change already in progress. The family 
resemblance between all four curves is striking. 

Section 4. — Fifteen years a safe minimum estimate of prolongation possible. 

The estimate of fifteen years as the possible prolongation of life 
is merely a minimum estimate. This will be seen from the following 
important considerations: 

1. The estimate takes no account of future medical discoveries, 
which are now coming at such a rate that we have every reason to 
believe they will soon greatly increase the ratios of preventability. 
Cancer, for instance, has been put down with zero as its ratio of pre- 
ventability, but* the scientific world is intently seeking for methods 
of prevention and cure. Likewise " old age has been assumed as 
unpreventable. Yet Metchnikoff maintains with reason that this 
is a malady which can be postponed. 

2. The ratio of preventability of the above diseases takes little 
account of the cumulative influence of hygiene. Certain diseases late 
in life are now taken to be unpreventable or only slightly prevent- 
able on the assumption that people reach those ages in their present 
degree of more or less imperfect health. But on the assumption that 
personal hygiene had been practiced since birth, the vital resistance, 
which is always a deterrent of disease, would have been strengthened. 



° See Dr. Edward Jarvis, " Political Economy of Health,' 
port, Mass. Board of Health, 1874, p. 338, ff. 

S. Doc. 419, 61-2 8 



Fifth Annual Re- 



732 EEPOKT OF NATIONAL CONSERVATION COMMISSION. 

Professor Sedgwick tells us that evidence will be published demon- 
strating " Hazen's theorem," that every life saved from typhoid by 
better water supply means two or three persons saved from deaths 
from other causes. Our table shows an estimate of at least 85 per cent 
as the preventability of typhoid, but the coincident preventability of 
other diseases which this prevention of typhoid would bring about 
finds no place in the table. The individual estimates given for these, 
other diseases take no account of such indirect action. Similarly, 
as Metchnikoff has emphasized, venereal diseases, though they sel- 
dom cause death, do shorten life, the " terminal disease " being quite 
different. The same is true of malaria and hook-worm disease, which 
predispose to tuberculosis and other terminal diseases. But in the 
table the ratios of preventability of tuberculosis and other diseases 
were constructed quite irrespective of any effect from reducing 
venereal diseases, malaria, and other devitalizing diseases. 

In the matter of personal hygiene the cumulative influence is still 
more indirect, and perhaps still more powerful. It is now often 
remarked by insurance men that the best risks are not necessarily 
the best physiques, but may be the valetudinarians who practice per- 
sonal hygiene. 

There is a vicious circle of disease and a beneficent circle of health. 
The so-called " cause of death " given in death certificates is only the 
terminal cause. It is often merely the " last straw " of a terrible load 
gradually accumulated through life. 

Evidently, to exploit the resources of hygiene, we need to consider 
a thoroughgoing change in health ideals and a consequent revolu- 
tion in the conditions and habits of living. What would then happen 
to human longevity we can only conjecture. The possible addition 
to the life span might, for aught we know, be several times the fif- 
teen years in the table. 

3. The figures for the possible prolongation of life take no account 
of the ultimate racial effects of the new health ideals. If once a 
nation becomes thoroughly alive to the importance of maintaining 
the stamina of its citizens, this will, as we have seen, affect mar- 
riages — by putting a premium on health as one of the desiderata in 
a prospective husband or wife. The longevity of succeeding genera- 
tions would certainly be improved — how much, it would be useless 
to guess. 

The foregoing considerations, added to the fact that the estimates 
of preventability were made conservatively, will show that the addi- 
tion of fifteen years is really only a first step. If clean milk will 
prevent infantile diarrheal diseases, if clean water will prevent 
deaths from typhoid and at the same time — according to Hazen's 
theorem — prevent two or three times as many other deaths, and if 
clean air will prevent tuberculosis, then it is evident that mere 
cleanliness in respect to these necessities will suffice to lengthen life 
by most if not all of the above estimate: Fifteen years is merely the 
" ore in sight." If we will work for it, we may get an even richer 
prize. 

Within the past few years the knowledge of the causes of disease has become 
so far advanced that it is a matter of practical certainty that by the unstinted 
application of known methods of investigation and consequent controlling action, 
all epidemic disease could be abolished within a period so short as fifty years. 

°E. Ray Lankester, "The Kingdom of Man," New York (Holt), 1907, p. 36. 



fishbr.] NATIONAL VITAL/ITT. 733 

Section 5. — Need of lengthening human life. 

If Metchnikoff's noble dream should be some day realized, the 
lengthening of human life would at once decrease the burden on the 
productive period. That period tends to remain 55 per cent of the 
total years lived, on the assumption that the working period remains 
17 J to 60, but the upper limit tends to shift forward. In this way, 
both the absolute and relative length of the working period would 
be increased. 

The further off the burden of old age is shifted, the easier it is 
for society or the individual to accumulate the wealth to provide for 
it. At present the burden of helpless old age is extremely serious, 
as those countries are beginning to realize which, like Denmark, 
Belgium, Germany, France, and recently England, have enacted laws 
to provide old-age pensions. 

As life becomes more complex it requires a longer period of prepa- 
ration. Preparation is education, and requires time. As the stock 
of knowledge increases, the period for acquiring it, or rather only 
enough of it to enable one to earn a livelihood, is constantly tending 
to increase. The age of leaving school and college is presumably 
growing greater. 

It would be very much in keeping with the fitness of things if in 
this century biological science practically applied should shift the 
limit of the further end of the working period, the limit which we 
have assumed to be 60, to a later period of life. Human life would 
then be on a larger scale throughout. It would provide time for a 
longer and more thorough preparation and at the same time provide 
sufficient years of working life to repay this investment. 

As Metchnikoff well points out, one result of lengthening life 
will be a greater utilization of accumulated experience. We shall 
have less immaturity of judgment. The principle which leads to 
the choice for members of the judiciary of men of ripe years and 
knowledge will apply to every field of human activity, even those fields 
which are now preempted by young men because of the necessity 
of utilizing their vitality. It will lead to a sane and yet a vigorous 
conservatism. It will give to society a body of old yet hale men of 
experience, whose influence and worth can not be measured. As 
Metchnikoff has said : 

Old age, at present practically a useless burden on the community, will become 
a period of work valuable to the community. As the old man will no longer 
be subject to loss of memory or to intellectual weakness, he will be able to 
apply his great experience to the most complicated and the most delicate parts 
of the social life. 6 

We may predict that when science occupies the preponderating place in human 
society that it ought to have, and when knowledge of hygiene is more advanced, 
human life will become much longer and the part of old people will become much 
more important than it is to-day. c 

Section 6. — The normal lifetime. 

What is the normal human lifetime ? d Many estimates have been 
made, based on all sorts of reasoning, the figures extending from 75 

° Prolongation of Life, p. 329. 

6 Nature of Man, p. 295. 

c Metchnikoff : " Prolongation of Life," pp. 226-227. 

d On the topic of human longevity, see Metchnikoff : " The Prolongation of 
Life," Pt. II, Chaps. I, II. Shaler : " The Individual," New York ( Appleton ) , 1901, 
Chap. III. Lankester : " Comparative Longevity," London, 1870, pp. 88-119. 



734 REPORT OF NATIONAL CONSERVATION COMMISSION. 

to 200 years. Flourens's law, of doubtful value, that a mammal lives 
five times the length of its growing period, can not be applied gener- 
ally. It is true, the horse full grown at 5 may live 25 years; sheep 
adult at less than 3 years may live 12 ; while elephants, which have an 
unusually tardy development, are reputed to have a lifetime of 2 
centuries. 

Haller, a distinguished Swiss physiologist of the eighteenth century, thought 
that man ought to live to 200 years; Buffon was of the opinion that when a 
man did not die from some accident or disease he would reach 90 or 100 years. 

In man the growth period is normally continued to some time after the 
twentieth year ; its exact limit has not been ascertained, but from the statistics 
gathered by the Sanitary Commission during the civil war it seems most likely 
that it is not usually completed until after the thirtieth year. & 

One method which has been suggested to ascertain the natural 
length of life is to suppose all diseases to be completely eliminated 
and those who now die of them to die of old age. The median age 
for death from old age is 83. Metchnikoff, however, shows the error 
of assuming present old age to be normal. We may conclude that 
the normal life exceeds 83. 

There must needs be, of course, a limit to the possible prolongation 
of life. We find in recent times few authenticated cases of persons 
who have lived for a hundred years. As Young, former president of 
the British Actuarial Society, has shown in his interesting book c on 
centenarians, most cases of supposed centenarians are either cases of 
conscious or unconscious exaggeration or of error in records. For 
instance, the Countess of Desmond is said to have lived 130 years, 
owing to the confusion of two persons of the same name, one of whom 
lived to be 100 years old, while the other, her mother, died at 30, and 
their lives were combined in subsequent records. There are, however, 
some authenticated cases. Thus, the Norwegian Drakenberg was 
born in 1626 and lived until 1772, aged 146. " He was married when 
111 years old, and as a widower of 130 proposed to marry again, 
although without success." d 

At Portland, Oreg., Mrs. Mary L. Wood died recently at the age 
of 120 years and under circumstances which permitted the authenti- 
cation of her case by the Oregon Historical Society. From these and 
from other cases which might be mentioned, we may conclude that 
if to-day, notwithstanding all existing chances of death, it is possible 
for some persons to live beyond 120, the chances in the future for a 
larger proportion of such persons will be materially improved. 
Whether this proportion could ever become the major part we have 
as yet no means of knowing. What is needed is study, and Metchni- 
koff is right in believing that the study is well worth while from 
every point of view. 

Appendix to Chaptee XI. — Method of computing possible prolongation of life. 
Section 1. — " Expectations " at median ages as short cut to average expectations. 

The table given in Chapter XI is briefly described in the chapter itself. The 
following additional explanations are made in regard to the statistical method 
employed : 

« Metchnikoff, " Prolongation of Life," p. 84. 
* Shaler, loc. cit, p. 61. 

C T. E. Young: "Centenarians," London (C. & E. Layton), 1899. 
d See article by Harald Westergaard, (British) Economic Journal, Vol. IX, 
1899, p. 315. 



fisher.] NATIONAL VITALITY. 735 

The third column, giving the expectation of life which is lost or cut off by 
each particular cause of death, is estimated roughly by taking the expectation 
of life pertaining to the median age reached by those who die from the cause 
named. This expectation of life is taken from the Massachusetts Life Tables, 
1893-1897.° 

The method of using the median age is sufficiently exact in view of the inexact, 
or rather, safe, minimum estimates of preventability given in column five. A per- 
fectly correct method would be much more laborious. Hayward's monograph 
on the effect on the duration of life of eliminating only one disease (tubercu- 
losis) requires 190 pages of calculation. The true method consists in averaging 
arithmetically and weighting these averages according to the number dying at 
the various ages. Specimen computations show that the error involved by the 
short cut is not great. 

Thus, for tuberculosis it is found that the average expectation of life lost 
by consumptives dying in 1906 was 32 years, whereas the expectation of life 
at the median age was 33 years. The former figure is a hundredfold more diffi- 
cult to compute than the latter. Even the former is not strictly correct, since 
it applies to the deaths by ages as distributed in 1906, and not as distributed in 
a " stationary " population. 

Section 2. — Basis of estimates of preventability. 

The estimates of preventability given in column 5 need special explanation. 
In a few cases, these estimates are based on statistical experience. 6 

The great majority of them are based on clinical experience merely, without 
any exact statistics. They are thus in the nature of expert guesses. The 
experts in all cases are physicians. I have not entered any estimate of my 
own, unless item No. 36 might be so designated. This item is the residuum of 
deaths from unknown causes, or ill-defined causes, and is made up to a large 
extent of cases not properly reported in the death certificates. Inasmuch as the 
average preventability for all other causes in the table is over 42 per cent, it 
seemed safe to assign to deaths from these unknown causes a ratio of pre- 
ventability of 30 per cent. But even if the preventability were entered as 0, 
the effect in reducing the result would be less than a year. 

Those who gave to the construction of these estimates the benefit of their 
experience, observations, and reading were especially asked above all to be con- 
servative. In order to avoid any possibility of exaggeration of their estimates 

° S. W. Abbott, M. D. : " The vital statistics of Massachusetts for 1897, from 
the thirtieth annual report of the state board of health of Massachusetts." 
The expectation is taken as the average of the expectations for males and 
females. 

b In addition to the data in regard to special diseases discussed in the text, 
other pertinent material has been taken into account by those who made the 
estimates presented in the table. For instance, from smallpox in London in 
H 901-2 the mortality was 34.6 per cent among the un vaccinated, 20.9 per cent 
among those vaccinated after the disease was apparent, and 10.3 per cent where 
there was protective vaccination. In Gloucester in 1895-96 the mortality among 
the unvaccinated was 40.8 per cent and among the vaccinated 9.8 per cent. For 
children under 1 year the unvaccinated had a mortality of 72 per cent, while 
the vaccinated were not attacked. From cerebro-spinal meningitis the average 
mortality was 70 per cent (Holt) ; the mortality under serum treatment was 25 
per cent (Flexner and Jobling). For typhoid fever, Koch and his assistants 
stamped out the disease in Trier by isolation of the infected persons and dis- 
infection. (Osier, The Practice of Medicine, sixth edition.) This would prob- 
ably be impracticable to such an extent in a city on account of the great expense 
involved and the difficulty of detecting the bacillus carriers. Other figures for 
typhoid fever are given in the text. For diphtheria in New York City in 1889- 
1891 we find the mortality was 37.3 per cent, while in 1902-1904 the mortality 
was 10.8 per cent. The board of health began to use antitoxin in 1895. These 
facts were furnished by Professor Blumer. Many data on preventability are 
given by John C. McVail in The Prevention of Infectious Diseases, New York 
(Macmillan), 1907. See especially pages 16-19. Doctor Stiles, of the Public 
Health and Marine-Hospital Service, is soon to publish figures showing the 
absolute preventability of hook-worm disease, a malady prevalent in the South, 
but not entering into the census tables. These tables do not cover the Southern 
States. 



736 KEPOET OF NATIONAL. CONSEEVATION COMMISSION. 

In the table their average was taken, and then the estimate, as entered in the 
table, was taken either as that average or below it. In no case was the estimate 
entered as above the average given. When, as was true in a large proportion 
of cases, the different estimates agreed fairly well, the average was employed, 
or rather the nearest figure ending in 0, or 5 next below the average. If the 
individual estimates diverged widely, an estimate was used below the average, 
favoring the conservative estimators rather than the optimistic. Also in cases 
where only a few estimates were obtainable, the estimate as entered was put 
below the average of those given. 

In estimating the percentage of preventability for all the ninety causes of 
death, 18 estimators contributed. The number of estimates of preventability 
for each cause averaged nearly eight for each cause of death. It will be seen, 
therefore, that the table represents in a conservative way medical opinion as to 
the preventability of disease. The physicians who contributed these estimates 
are : Dr. Joseph M. Flint, professor of surgery, Yale Medical School ; Dr. George 
Blumer, professor of the theory and practice of Medicine, Yale Medical School ; 
Dr. H. L. Swain, clinical professor, Yale Medical School ; Dr. Oliver T. Osborne, 
professor of therapeutics, Yale Medical School; Dr. J. H. Townsend, secretary 
of Connecticut state board of health ; Dr. F. W. Wright, health officer of New 
Haven ; Dr. Norman E. Ditman, of Columbia University ; Dr. Cressy L. Wilbur, 
Chief of Division of Vital Statistics, Bureau of the Census ; Dr. L. O. Howard, 
Chief of Bureau of Entomology, Department of Agriculture; Dr. William C. 
Woodward, chief health officer of District of Columbia ; Dr. Charles V. Chapin, 
city health officer, Providence, R. I. ; Dr. Henry B. Baker, ex-secretary Michigan 
state board of health, ex-president American Public Health Association ; Dr. 
J. H. Kellogg, superintendent of the Battle Creek Sanitarium; Dr. Charles H. 
Castle, of Cincinnati, Ohio ; Dr. Harry M. Steele, of New Haven, Conn. ; 
Dr. L. Emmett Holt, of New York; Dr. Edwin O. Jordan, of the Memorial Insti- 
tute for Infectious Diseases, Chicago, 111. ; Dr. Prince A. Morrow, president of 
the American Society for Sanitary and Moral Prophylaxis. 

Section 3. — Meaning of " preventable." 

The meaning of the word " preventable " requires some explanation. 

1. It is to be noted that column 5 gives the ratio of preventability for mor- 
tality and not for morbidity. It means ratio of preventable deaths to all deaths, 
not to all cases of illness. 

2. Since the word " preventable " implies the hypothesis of different conditions 
from those which actually exist, it is necessary to specify what hypothetical 
conditions shall be implied in the term. Doubtless tuberculosis would be over 
99 per cent preventable if we should conceive as our hypothetical conditions that 
every individual could live on the prairies of the West, out of doors, be provided 
with the best of food, most congenial of tasks, and free from overwork and 
worry. Needless to say, the figures in the table do not imply such Utopian con- 
ditions, nor do they imply new medical discoveries. One hundred per cent of 
every disease might be preventable if we conceived as our hypothesis that the 
means of prevention are known and applied. The hypothetical condition 
selected for the meaning of the term " preventable " is contained in the following 
definition : A " ratio of preventability " is the fraction of all deaths which 
would be avoided if knowledge now existing among well-informed men in the 
medical profession were actually applied in a reasonable way and to a reason- 
able extent. The term " reasonable " is of course elastic, and will be somewhat 
differently interpreted by different persons, but, as in law, where " reasonable 
care " is often used as a proviso, it is impossible to make any more specific 
condition. 

3. Considerable confusion exists in the minds of many people in regard to the 
number of deaths which might be prevented, or, as it is popularly expressed, 
the number of lives which might be saved. Since death is ultimately inevitable 
for all, no life can be saved except temporarily. It will serve to avoid confusion 
if " preventable " is explained as " postponable." The question arises when 
deaths are postponed, How long are they postponed? The answer is, They are 
supposed to occur according to existing rates of mortality. Thus, those saved 
from croup (No. 12) at age 2 will later die as do others who are living at age 2, 
and will therefore have the expectation of life (54 years) pertaining to that age. 

4. The above explanation will serve to meet an objection which otherwise 
would immediately occur to the reader. If diseases of early life are prevented, 
the result will necessarily be an increase of the diseases in later life. For 
instance, if all the causes of death could be abolished except old age, there 



fisher.] NATIONAL VITALITY. 737 

would be a great increase in the number of deaths from old age, which, instead 
of constituting the 2 per cent of all deaths, which it does at present, would con- 
stitute 100 per cent. 

But the fact that all lives saved will add to the later mortality is fully, and 
more than fully, taken into account in our calculations. When we assume that 
certain lives now lost at a given age might be saved, we also assume that they 
would not be saved again (even from the same disease), but would die off 
according to the old rates of mortality at successive ages. Their new lease of 
life would simply be the old expectation of life. As a matter of fact, lives now 
lost could probably be saved, not only once, but several times. 

We may here explain the paradox mentioned in the text — namely, that a 
preventability of 42.3 per cent of deaths under present conditions does not imply 
that the death rate would ultimately be reduced 42.3 per cent. 

The death rate would ultimately depend on conditions of the distribution 
of ages and diseases entirely different from those now prevailing. This will 
be clear if we think what would happen if the preventability expressed in the 
table could be immediately applied. During the ensuing year it would be found 
that about 42 per cent of present deaths would not occur. A consequence of 
this, however, would be that the persons whose lives were prolonged would die 
at a later period, since no death is absolutely prevented, but only postponed. 
Even if 100 per cent of all deaths were prevented (postponed), but the post- 
ponement were for a very short time, the effect in reducing the death rate 
would be extremely small. On the other hand, if only 1 per cent of the prevent- 
able deaths were postponed for a sufficiently long time, the ultimate effect would 
be to reduce the death rate much more than 1 per cent. After the deaths 
which had been postponed had reentered, a new equilibrium would be estab- 
lished. Under these new conditions the ratio of the deaths to the population 
would not be 42.3 per cent lower than at present, but only about 25 per cent. 
At present the average duration of life, taken from the Massachusetts table 
for 1893-1897, is about 45 years. The ratio of preventability in the above table 
would increase this life by about fifteen years, making it 60 years. The ratio 
of 45 to 60, showing the increase in the life span, will be the inverse of the 
ratio 60 to 45 in a " stationary " population, which would show the resulting 
reduction in the death rate. This is a reduction of 25 per cent. Thus the pre- 
ventability of 42.3 per cent of deaths under present conditions and in the man- 
ner indicated in the table involves a lengthening of life of 33£ per cent and a 
reduction of the death rate, after readjustment of deaths by ages, of about 25 
per cent. 

Section 4. — Error from abnormal age distribution of deaths in 1906. 

The table as given is constructed for deaths occurring in the calendar year 
1906. Its interpretation, however, is to be made on the basis of a survivorship 
table. In a stationary population the age distribution of deaths in any year 
would be the same as in a survivorship table; but since the United States has 
not a stationary population, this identity holds only approximately. 

The discrepancy accounts for the difference of one and three-tenths years in 
the prolongation of life, as calculated in the table and by means of the dia- 
gram. The latter is the more correct, as it is based on a survivorship table, 
or — what amounts to the same thing — on such mortality as would exist in a 
stationary population. The only way in which this diagram can be vitiated 
by the slightly abnormal age distribution of deaths in the year 1906 is as this 
abnormal distribution affects the average ratios of preventability used in con- 
structing the diagram. These ratios are based on column (5) of the resume 1 
of the table. The four figures from the table are adjusted by graphic interpola- 
tion in the usual way, so as to form a continuously varying series of figures for 
successive years of life. These ratios are in each case an average of the indi- 
vidual ratios for particular diseases, contained in the same column (5) of the 
larger table. The " weights " are slightly vitiated by the fact that the age dis- 
tribution of deaths in 1906 is not the normal distribution of a stationary popula- 
tion. It is only as the " weighting " is thus affected that the diagram can be 
vitiated through our being forced to use the figures for 1906 instead of those 
for an ideal stationary population, since such figures are unobtainable. The 
error from this source is infinitesimal, and we may depend on the results of the 
diagram, 12.8 to 14.9 years, as practically free from any appreciable error due 
to the use of short-cut methods. 



738 REPORT OF NATIONAL CONSERVATION COMMISSION. 

Section 5. — Ratios of preventability by ages derived from ratios by diseases. 

In regard to the resume containing the average ratios of preventability hold- 
ing true during different ages, it will be observed that they are obtained indi- 
rectly, by calculating from the individual ratios of preventability for different 
diseases given in the table itself. Although these diseases are not absolutely 
limited to the times within which their median falls, there is a fairly distinct 
line of demarcation between the groups, especially between children's diseases 
and those of middle life. The table shows no disease with a median age of 
incidence between 8 and 23 years, and the census table of deaths for 1906 shows 
that a very small percentage of the total deaths occur between ages 10 and 20. 
Even if the diseases considered for the four epochs of life given in the resume 
did extend somewhat into the regions of the adjacent epochs, the effect would 
not change the result appreciably and would be as likely to chaDge it in one 
direction as the other. The reason is that the items of the column in the 
resume for " ratio of preventability " are obtained by dividing the figures in 
column 6 by those in column 4, each of these two being found by adding the 
individual figures in the table for each age group concerned. The extension 
of diseases of an age group outside of that group will apply equally to both 
terms of the ratio, those in the fourth and sixth columns, and will not substan- 
tially affect the quotient in the fifth column. 

Section 6. — Alloivance for weakness of prolonged lives. 

The use in column 2 of the expectations of life derived from the Massachu- 
setts 1893-1897 life table is equivalent to the assumption that if preventable 
deaths were prevented the lives thus saved would proceed to die off according 
to the mortality of Massachusetts, 1893-1897. This assumes that since 1893-1897 
there has been no improvement in the expectation of life, and that the saved 
lives will not share in the improvement which the table itself shows forth. The 
reason that a later life table than for 1893-1897 was not used is that no later 
life table is available. If it were, it would show larger figures in column 2, 
and consequently a larger total result for the possible prolongation of life than 
fourteen years. 

The reason the " expectation " in column 3 does not take account of the effect 
of the improvement in mortality resulting from the table is that this improve- 
ment can not be calculated until column 3 is filled, and we prefer to use as a first 
approximation a conservative figure in column 3, rather than to guess at more 
likely figures. The conservative assumption used seems also advisable, because 
of the fact that in the 42.3 per cent of persons in the life table who would be 
saved from death and given a new lease of life there would be suffered a greater 
mortality than that of the average persons that now pass that age in safety, 
for — on the principle of the survival of the fittest — it is intrinsically probable 
that those who now die at any age are weaker than those who do not. 

How much allowance should be made for this factor of differential mortality 
it is impossible to say with certainty. But in another paper a I have dealt with 
the same question applied to tuberculosis. Taking the figures of Dr. Lawrason 
Brown, giving the mortality experience among the apparently cured cases of 
tuberculosis discharged from the Adirondack Cottage Sanitarium, and making 
certain allowances, it seems that if tuberculosis were prevented its present vic- 
tims would have more than three-fourths of the expectation of life belonging to 
others. Let us assume that this ratio is equally conservative as applied to all 
other cases of prolongable life. Now, it so happens that the expectation of life 
at birth in the Massachusetts life table of 1893-1897 is almost exactly three- 
fourths of the expectation which our table and diagram shows would be possible 
if prevention were properly practiced. This would give 45 years as the expecta- 
tion of life at birth for the saved lives, 61 for other lives, and 59 for all lives. 
Surely this seems sufficient allowance for the existence of any possible inferior- 
ity among the lives which would be saved. 

Section 7. — Diagram "Possible 1? making this allowance, compare* with "Possible II," 

omitting it. 

If no allowance for inferiority among saved lives were necessary, the results 
of the calculation given in the table would be only a first approximation and 

° "The cost of tuberculosis in the United States and its reduction," read before 
the International Congress on Tuberculosis, 1908. 



fisher.] NATION ALi VITALITY. 739 

would need to be followed by successive and closer approximations. We can get 
much quicker results by means of the diagram and a planimeter. 

If we apply the ratios of preventability for these four groups, we are able to 
construct the new survivorship table on the basis of Mr. Abbott's for 1893-1897. 
All that is necessary is to begin the new survivorship table at the same point 
that the old begins, and continue from that point and every other point through- 
out its course by the following procedure : Through the point draw a line down- 
ward and to the right for one year, at the same percentage slope as Abbott's 
table shows for that year. This line indicates what survivors there would be if 
their mortality were not affected at all by the ratio of preventability. The 
deaths during that year would be represented by the drop of the curve within 
the year. Next, taking the proper fraction of this drop, as indicated by the 
ratio of preventability, we pass vertically upward this amount from the end of 
the line, and from the new point so obtained proceed in like manner for each 
subsequent year. The result is a series of teeth the upper points of which are 
points on the required curve. Joining these points, we obtain the curve. This 
process explains the theory. This gives the table called " Possible I," and takes 
full account of the fact that the ratios of preventability continue to apply to 
saved life as much as to other life. The table " Possible I " represents the sur- 
vivorship table, under the assumption that the lives saved once are given no 
further advantages, but follow thereafter the old law of mortality, that for 
1893-1897. 

Section 8. — Reciprocal relation between longevity and mortality shown by diagram. 

We may take this opportunity to explain, for the benefit of the general reader, 
the reciprocal relations existing between the death rate in a stationary popula- 
tion and the average duration of life. Consider the diagram " Massachusetts, 
1893-1897." It shows the life history of 100,000 persons born. Let us suppose 
a community unaffected by emigration or immigration, and in which there are 
100,000 births each year. Let us suppose, further, that the 100,000 persons born 
each year die afterwards according to the law of mortality represented by the 
curve " Massachusetts, 1893-1897." Evidently in such a community there will 
not only be 100,000 births, but there will be 100,000 deaths each year, and the 
population will be stationary. It will also be true that the same diagram can 
be taken to represent the age distribution of this stationary population. Thus, 
those living at age 10 will be the survivors of the 100,000 born ten years ago, 
and the number of such survivors is the ordinate of the curve at 10 years. 
Thus, every ordinate of the curve represents not only the survivors to a certain 
age out of 100,000 births, but also represents the number in the population at 
that age. The area of the curve therefore represents total population (when 
regarded as made up of vertical sections). It likewise represents the total 
number of years lived by 100,000 persons (when regarded as made up of hori- 
zontal sections). Now, the death rate is the ratio of deaths to population — i. e., 
the ratio of 100,000 to the area of the curve. The average duration of life is 
the total years lived by 100,000 persons divided by 100,000 — that is, it is the 
area of the curve divided by 100,000. These are clearly reciprocals. 

Chapter XII. — The money value of increased vitality. 
Section 1. — Money appraisal of preventable wastes. 

Estimates of the money value of preventable wastes depend on the 
valuation of human life, of which several appraisals have been 
attempted. 

Prof. J. S. Nicholson estimated that in Great Britain human labor 
capitalized was worth five times all other capital. 

Engel computed that each child costs 100 marks at birth, 110 marks 
the first year, 120 the second, and so on. At 20 he will have cost 
2,310 marks, or $560. But one-half die before 20. Hence each per- 
son who reaches the age of 20 actually costs society much more than 
$560; possibly as high as $1,000, if Engel's estimates are correct. 
Professor Mayo-Smith estimated that men and women between the 

° See " The Living Capital of the United Kingdom," (British) Economic 
Journal, 1891. 



740 



BEPOBT OP NATIONAL. CONSERVATION COMMISSION. 



ages of 15 and 45 averaged $1,000 in valued As to the value of immi- 
grants to this country, he says : " Every immigrant must represent 
labor value with at least the value of a slave. It is figured that each 
immigrant is worth $875." b 

The best method of estimating the economic value of life and its 
increased duration is by the capitalization of earning power. Dr. 
William Farr, of England, has estimated that a baby born to an 
English agricultural laborer is worth in capitalized earning power 
about £5, or $25. This is the discounted value of its future earnings 
estimated on its probable life less the discounted value of the cost 
of rearing it during the period of dependence and of maintaining 
it when helpless through old age. In the same way he estimates the 
value of a life at other ages — 10 years, 20 years, 50 years, etc. c 

In lieu of any estimates for the United States we may take Farr's 
figures for agricultural laborers as representing, roughly, the rela- 
tive worth of a man or woman in the United States. To obtain the 
absolute figures, therefore, we need simply to multiply these of Farr 
by a constant factor representing the ratio between the average earn- 
ings in the United States and the earnings which Farr uses as the 
yearly income of an agricultural laborer. 

We take, in the absence of any good statistics, $700 per annum as 
a guess, but a safe minimum d for the average earnings of workers of 
all grades, from day laborers to railroad presidents. This assumes 
that all of the working years are actually employed in work. But 
since about one-fourth of the persons of working age are not workers, 
but are supported (for the most part) by earnings of capital, the 
average should be cut down to three- fourths of this figure, or $525. 

Substituting this figure for the £31 in Farr's table, we can recon- 
struct it to represent the minimum worth of the average American 
life at different ages. The following figures are taken from the 
table thus computed : 



Age. 


Net 

worth of a 

person, in 

dollars. 


Age. 


Net 

worth of a 

person, in 

dollars. 





90 

950 

2,000 

4,000 


80 


4,100 


5 


50 


2,900 
-700 


10 


80 


20 











From the table from which these figures are taken it is possible to 
base minimum estimates for (1) the average economic value of the 
inhabitants of the United States by using the census figures for age 

° Mayo-Smith, Statistics and Sociology, p. 177. 

6 Mayo-Smith, Emigration and Immigration. 

c See Farr, " Vital Statistics," p. 536. 

d See Fisher " Cost of tuberculosis," read before the International Congress 
on Tuberculosis, Washington, 1908. This is the estimated minimum used in 
my paper on the " Cost of tuberculosis." The calculations are based on $1 a 
day as the ordinary minimum earnings of unskilled labor, and assume a dis- 
tribution of a number of earners of high amounts according to the scale of 
distribution which Professor Pareto finds fairly uniform in form, although not 
in amount in various countries. The late Honorable Carroll D. Wright, whose 
opinion was worth more, probably, than that of any other man in the United 
States, stated that he would not regard $1,000 as excessive. The figure is 
intended to include the earnings of women (including housewives as earners). 



fishie.] NATIONAL VITALITY. 741 

distribution of population ; this calculated average is $2,900 ; (2) the 
average economic value of the lives now sacrificed by preventable 
deaths, using the age distribution of deaths, and the percentages of 
pre vent ability ; this calculated average is $1,700. 

The first figure shows that what might be called the vital assets of 
the United States for the population of over 85,500,000, as estimated 
by the census of 1907, amount in value to 85,500,000 X$2,900, or 
$250,000,000,000, which, though a minimum estimate, greatly ex- 
ceeds the value of all other wealth ; ° the second figure enables us to 
estimate the needless waste of our vital assets. 

If we take the estimate of Professor Willcox of the death rate in 
the United States, as at least 18 per 1,000 for the 85,500,000 persons 
estimated by the census as the population of the United States in 
1907, we have 1,500,000 as the number of deaths in the United States 
per annum. Of these 1,500,000 deaths, 42 per cent, or 630,000, are 
annually preventable or postponable. Since each postponement 
would save on the average $1,700, the national annual unnecessary 
loss of capitalized net earnings is 630,000X$1,?00, or $1,070,000,000, 
or about $1,000,000,000. 

We saw in Chapter III that, with our present population, there 
are always about 3,000,000 persons in the United States on the sick 
list. For the most part these persons are older than the average. 
Farr gives a table & showing that morbidity increases with age in 
geometric progression. By means of his table we may calculate on 
the same basis as the previous calculations — that of the 3,000,000 
sick, very close to a third, or 1,000,000 persons, are in the working 
period of life. Assuming that average earnings in the working 
period are $700, and that only three-fourths of the one million poten- 
tial workers would be occupied, we find over $500,000,000 as the mini- 
mum loss of earnings. 

The cost of medical attendance, medicine, nursing, etc., is con- 
jectured by Doctor Biggs in New York to average for the con- 
sumptive poor at least $1.50 per day of illness. The cost per day of 
other illnesses than tuberculosis is presumably greater, and also the 
cost per day for other classes is higher than for the poor. Applying 
this to the 3,000,000 years of illness annually experienced, we should 
have $1,500,000,000 in all as the minimum annual cost of this kind. 

The statistics of the Commissioner of Labor c show that the average 
expenditure for illness and death amount to $27 per annum. This 
is for workingmen's families only. But even this figure, if applied 
to the 17,000,000 families of the United States, would make the total 
bill for caring for illness and death $460,000,000. The true cost may 
well be more than twice this sum. Certainly this estimate is more 
than safe and is only one-third of the sum obtained by using Doctor 
Biggs's estimate. 

The sum of the costs of illness, including loss of wages and cost of 
care, is thus $460,000,000+$500,000,000, or $960,000,000. 

The above estimate is a general one for all illness. It would be 
possible to offer figures for the particular losses from particular dis- 

• Mr. Le Grand Powers, of the Bureau of the Census, Washington, estimates 
that the total wealth in America (exclusive of human beings) amounts to 
$107,000,000,000. 

• Vital Statistics, p. 510. 

• Eighteenth Annual Report, 1903, p. 509. 



742 REPORT OF NATIONAL CONSERVATION COMMISSION. 

eases. Thus, from tuberculosis, the gross loss of earnings by illness 
and of potential earnings cut on by death, together with the expenses 
of illness, etc., amount to over $1,000,000,000 per annum. 

Of the sum mentioned, the loss to the consumptives themselves 
amounts to over $660,000,000, leaving $440,000,000 as the loss to other 
members of the community. At least three-fourths of these costs 
are preventable. Dr. George M. Kober thinks it is conservative to say 
that the annual cost of typhoid in the United States is $350,000,000 b 
and Dr. L. O. Howard believes that malaria alone costs the country 
$100,000,000 annually, and the insect diseases generally $200,000,000. c 
He points out that one great item of loss is the reduced value of real 
estate in malarial regions. By drainage and destruction of mos- 
quitoes most of this waste could be saved. The cost of the care of the 
insane and feeble-minded is estimated by Charles L. Dana at $85,- 
000,000 annually .* What fraction of these costs is preventable it is 
difficult to say. The economic loss due to alcohol has been variously 
estimated. e Of the billion dollars or more found to represent the cost 
of illness, by far the major part is certainly avoidable. This is the 
belief of the best observers, such as Doctor Gulick, Doctor Kellogg, 
Mrs. Richards, Doctor Anderson, and others. Unfortunately there 
are no exact statistics of preventability. We feel safe, however, in 
concluding that at least half a billion could be saved from the pres- 
ent cost of illness. This, added to the loss by preventable deaths 
of potential earnings of a billion, gives at least a billion and a half 
of preventable waste. This does not include the losses from inef- 
ficient work due to drunkenness or other vicious habits; nor does 
it include the cost of " undue fatigue," which we have some reason 
to believe exceeds in its effect on efficiency the loss from illness. But 
it would not be possible to state this loss in any definite or convincing 
figures. 

The actual economic saving annually possible in this country by 
preventing needless deaths, needless illness (serious and minor), and 
needless fatigue, is certainly far greater than one and a half billions, 
and may be three or more times as great. 

Dr. George M. Gould estimated that sickness and death in the 
United States cost $3,000,000,000 annually, of which at least a third 
is regarded as preventable/ 

The trouble is the public does not believe in this waste from being " just 
poorly," and " so as to be about." It has no conception of the difference 
between working with a clear brain and steady hand and with a dull and 
nerveless tool. They must be convinced somehow. 8 ' 

° See Irving Fisher : " Cost of Tuberculosis in the United States, acd its 
Reduction." 

6 See his " Conservation of life and health by improved water supply," read 
before the White House Conference of Governors, 1908. 

c Report to Conservation Commission on " Economic loss to the people of the 
United States through insects that carry disease." 

d See " Psychiatry in its relation to other sciences," by Charles L. Dana, before 
the section on psychiatry at the International Congress of Arts and Sciences, 
St. Louis, September, 1904. 

e " Economic aspects of the liquor problem." An investigation made for the 
Committee of Fifty, under the direction of Henry W. Farnam, secretary of the 
economic subcommittee, 1899, 327 pages. 

f " Disease and Sin," American Medical Journal, August 31 and September 
7, 1901. 

o Letter from Ellen H. Richards. 



fisher.] NATIONAL. VITALITY. 743 

Section 2. — The cost of conservation. 

It costs no more to " raise " a man capable of living for 80 years than it does 
to " grow " one who has not the capacity of living to be 40 years old.° 

We have seen how much potential value of life is now allowed to 
be wasted which could be prevented. But the question remains, What 
would it cost to conserve it? It is, of course, not possible to answer 
this question definitely and fully. The best we can do is to point out 
specific instances of the health returns which follow on investments 
in the improvement of vital conditions. 

The following examples will show the returns which may be ex- 
pected from well-planned expenditures on behalf of public health : 

The city of Pittsburg is just installing a great municipal filter plant for the 
purification of its principal water supply, at an expense of upward of $7,000,000. 
It is reasonable to estimate that in a year or two this should effect a saving of 
100 deaths a year from typhoid fever, for the number of typhoid-fever deaths 
of late years has been 400 or more yearly. Valuing these lives at $5,000 each, 
as is customary, the saving effected by the purification works should be half a 
million dollars' worth of human life annually, making the building of the filter 
a sound and profitable economic as well as humanitarian measure. But if, as 
Mr. MacNutt and I have shown, Hazen's theorem is true, then for every 100 
deaths saved from typhoid fever at least 200 will be saved from other causes, 
which means at least $1,000,000 more saved to the city of Pittsburg annually of 
its present waste of human life. 6 

England reckons that the lives saved through the lowered death rate, from 
what it was between 1866 and 1875 to what it became in the period reaching 
from 18S0 to 1889, amounted to 858,804. This represents on the English basis 
of the per capita valuation of each life ($770) a social capital of $650,000,000 
saved. In ten years England has more than regained the sum spent in fifteen 
years for sanitary improvements, though the average annual expenditure has 
been $42,000,000/ 

The achievement of Huddersfield, England, is especially noteworthy. The 
average number of deaths of infants for ten years had been 310. By a system- 
atic education of mothers the number was in 1907 reduced to 212. The cost of 
saving these 98 lives was about $2,000. d 

A saving of infant life is recorded by Doctor Chapin in Providence : 

We attempted for two years to distribute clean milk to the babies of the poor, 
but this year we decided that the money could better be spent on trained 
nurses. Thus far we have expended about $900 for this purpose. Two hundred 
and thirty-five sick children, of whom very many were very sick, have been 
cared for. Of these only 20 have died. From a study of our statistics I should 
judge that the reduction in infant mortality effected by the nurses was at least 
25 deaths, and it may be that as many as 40 lives were saved. 6 

At the funeral of Maj. Walter Reed, the man who did so much to 
prove the correctness of Doctor Finley's discovery that the mosquito 
is the carrying agent for the yellow-fever germ, Gen. Leonard Wood 

a T. S. Lambert : " Sources of Longevity," New York, 1869, p. 6. 

&W. T. Sedgwick: "The call to public health," Science, 1908, p. 198. 

Since the foregoing was written, there has appeared in " Charities," February 
6, 1909, " Thirty Five Years of Typhoid " by Frank E. Wing, in which it is shown 
that- there were in 1907, in Pittsburg, 4,921 cases of typhoid, of which 622 died; 
and that the cost per patient, irrespective of the lives lost, was $128, making the 
cost for the city $694,000. Reckoning $4,000 as the value of each life lost, 
the total annual money cost from typhoid in Pittsburg is over $3,000,000, and, 
according to Hazen's theorem, already mentioned, this is probably not one-half 
nor even one-third of the total. 

c Ditman, loc. cit, p. 4. Taken from M. G. Dana : " Results of municipal 
sanitation," Annals of Hygiene, 1S96, Vol. II, p. 391. 

d Letter from Dr. Charles V. Chapin. 

• Ibid. 



744 REPORT OF NATIONAL CONSERVATION COMMISSION. 

declared that this discovery is saving more lives annually than were 
lost in the Cuban war, and that it is saving the commercial interests 
of the world a greater financial loss each year than the cost of the 
entire Cuban war.° 

As to what the stamping out of yellow fever means, in money 
terms, the following is significant: 

It has been estimated) that the yellow fever epidemic of 1878 invaded 132 
towns, caused a mortality of 15,954 persons, and that the pecuniary loss to the 
country was not less than $100,000,000 in gold.* 

The economic loss to Philadelphia, caused by the smallpox epidemic 
of 1871-72, has been estimated by Doctor Lee at $22,000,000. This in- 
cludes loss to travel and traffic on railroads, loss to hotel keepers, 
merchants, and manufacturers, cost of care of sick, loss of time, and 
the expense of burial. A vaccine bureau with physicians, a disinfect- 
ing station, and the inauguration of a campaign of education capable 
of forestalling the whole epidemic would have cost $700,000.° 

It is reported that San Francisco plans an investment of $30,000,- 
000 in stone and concrete quays to prevent rodents from infecting the 
city, and this is regarded by experts as worth while many times over. 

In respect to hook-worm disease, rating the earning per diem of the 
southern farm laborer at 75 cents, 28 observers report that average 
laborers infected with hook-worms earn 40 cents per diem. Ten ob- 
servers having cotton-mill practice report unanimously that the 
disease is very prevalent among cotton-mill laborers, and rating the 
average mill laborers at $1.50 per diem, they consider 75 cents as a 
fair rating for hook-worm bearing laborers.* 

It would be difficult to even roughly estimate the cost of this disease to the 
South, but from what we know of it in this State I woultf say that it costs South 
Carolina not less than $30,000,000 per year, and this inability to perform regular 
and efficient labor is the smallest part of the cost. e 

It has been figured that the hook-worm disease of the South could 
be wiped out within a generation f through the expenditure of from 
one to two millions of dollars by federal and state agencies. It costs 
about 15 to 75 cents (wholesale) for drugs to cure a case of hook 
worms. In three months the quantity of red corpuscles in the blood 
can easily be increased 10 to 50 per cent, according to the severity of 
the case, and the * absenteeism of the victims could easily be reduced 
25 per cent. 

Another noteworthy result of well-directed sanitary effort is the reduction of 
hook-worm disease in Porto Rico. As you are doubtless aware, this disease 
causes a tremendous lowering of the physical efficiency of the people of that 
island. As you may see by the report of the special commission for 1906 and 
1907 made to Governor Post, 89,000 people were treated, and for the most 
part cured, for 54 cents each> 

°Ditman, loc. cit, p. 12. 

6 Walter Wyman, M. D., " Quarantine and Commerce," address before Cincin- 
nati Commercial Club, October 15, 1898, p. 8. 

c Ditman, loc. cit., pp. 8-10, from Bissell, A Manual of Hygiene. 

* Letter from Dr. W. J. Burdell. 

e William Weston, " Uncinariasis," South Carolina Medical Association, 1908, 
p. 8. 

t Dr. Charles W. Stiles, of the United States Public Health and Marine-Hos- 
pital Service, who has studied the hook-worm disease more thoroughly than any 
one else in the country. 

Letter from Doctor Stiles. 

h Letter from Charles V, Chapin, 1908. 



fisher.] NATIONAL. VITALITY. 745 

i 

Medical inspection in our schools also returns large dividends on 
small investments. 

Using these data as a basis, we have the annual expenditure for medical 
inspection of $345,135 in those cities from which we have succeeded in obtain- 
ing data. It seems probable, although this is frankly a guess, that the total 
annual expenditure for medical inspection of schools in the United States at 
the present time is perhaps $500,000.° 

The money saved by enabling thousands of children to do one year's work in 
one year, instead of in two or three years, would greatly exceed the total 
expense of examining all school children in all boroughs. 6 

Doctor Jessen has shown that the cost of a school dental clinic in 
Germany is only one mark per year per child. The cost saved must 
be very many times this sum. Dr. Herbert L. Wheeler, of New 
York, estimates that the Children's Aid Dental Clinic in New York 
cost $342 for the last fiscal year (35 cents per operation and 70 cents 
per child treated) . He reckons that the neglect of these slight repairs 
would later have cost far more in dentistry, as well as over $2,000 
worth of lost time. These losses are of course of minor importance 
compared with the pain, inconvenience, and secondary effects on 
health and efficiency which are inevitably associated with bad teeth. 

Mr. Edwin Chadwick, who was once secretary of the English Na- 
tional Board of Health, stated that a sanitary "engineer ought to 
contract for the reduction of the sickness and death rate, in such a 
city as Glasgow, by at least one-third, for a penny a head of the 
entire population." d 

It is necessary, if we are to do our utmost, to spend a thousand pounds of 
public money on this task where we now spend one pound. It would be rea- 
sonable and wise to expend ten million pounds a year of our revenues on the 
investigation and attempt to destroy disease. Actually what is so spent is a 
mere nothing, a few thousands a year. Meanwhile our people are dying by 
thousands of preventable diseased 

Mr. Hiram J. Messenger, actuary of the Travelers Insurance Com- 
pany, of Hartford, has constructed and sent me a table showing that 
life insurance companies could probably make money now by taking 
a hand in the public-health movement, with the purely commercial 
object of reducing their death losses. He says: 

This table shows that if the companies were to expend $200,000 a year for 
this purpose and as a result should decrease their losses by the almost insig- 
nificant amount of twelve one-hundredths of 1 per cent, they would save enough to 
cover the expense. If such a plan as this were placed on a purely scientific basis 
and carried out by good business methods and all the companies pulled together 
for the common good, I should expect a decrease in death claims of more than 1 
per cent. And a decrease in death claims of 1 per c"ent would mean that the 
companies would save more than eight times as much as they expended or would 
make a net saving of more than seven times the expense — which would be about 
a million and a half dollars a year. 

The examples given show tangible returns on the investment of sev- 
eral thousand per cent as a rule. While it would be impossible to* 

° Letter from Dr. Luther H. Gulick. 

6 Sixty-third Annual Report of the Association for Improving the Condition of 
the Poor, New York, 1906. 

c See "Jahresbericht der Stadtischen Schulzahnklinik in Strassburg," in 
Odontologische Blatter 12, No. 15-16, 1907. 

d Transactions of the British Social Science Association, 1866, p. 580. Quoted 
by Dr. Edward Jarvis, Political Economy of Health, Fifth Report, Mass. Board 
of Health, 1874, p. 367. 

e E. Ray Lankester, "The Kingdom of Man," New York (Holt), 1907, p. 148. 



746 REPORT OP NATIONAL, CONSERVATION COMMISSION. 

state in general terms how rich a return lies ready for public or pri- 
vate investments in good health, the foregoing examples and numer- 
ous others show that the rate of this return is quite beyond the dreams 
of avarice. Were it possible for the public to realize this fact, motives 
both of economy and of humanity would dictate immediate and gen- 
erous expenditure of public moneys for improving the air we breathe, 
the water we drink, and the food we eat, as well as for eliminating 
the dangers to life and limb which now surround us. 

Chapter XIII. — The general value of increased vitality. 
Section 1. — Disease, poverty, and crime. 

In the preceding chapter we have attempted to estimate in money 
the preventable wastes from disease and death. Although the figures 
for national losses strike the popular imagination, they have little 
significance ; in fact, money estimates in this field, even when made on 
the per capita basis, are of little value except as emphasizing the 
overwhelming importance of human vitality compared with those 
interests which are usually measured in money. It is impossible in 
any true sense to measure human life in terms of dollars and cents. a 

The measure of life may perhaps be found in happiness, or the 
satisfactions enjoyed between birth and death, less the dissatisfactions. 

Is life worth living ? has been a much asked question, especially since 
Mr. Mallock wrote a book with that title. The witticism sometimes 
given in answer, " That depends upon the liver," is true in both of its 
two meanings. A life of happiness is always worth living, and a life 
of usefulness, which brings happiness to others, is doubly worth 
living. 

It is hardly necessary to recount all the conditions which tend to 
produce happiness. No one would question that the most funda- 
mental condition of all is health, in spite of exceptional cases in which 
unhealthy people are found happy, and healthy people unhappy. It 
would be impossible to express in exact terms the extent to which im- 
proved health could increase human happiness; but every observer 
of human misery among the poor reports that disease plays the lead- 
ing role. Students of criminology and vice agree that these are 
chiefly the result of morbid conditions and habits. Health reform 
brings in its train great and lasting reductions in poverty, criminality, 
and vice. 

We began this report by showing the relation between the conser- 
vation of health and the conservation of wealth. The broadest view 
of this relation is, as Emerson has said, that "Health is the first 
wealth," and as such it is treated by many economists. 6 

a Even as a measure of what economists call " utility," a money estimate is 
misleading, for the reason that the " marginal utility " of money varies with 
different persons. For instance, a week's wages of $10 lost to a poor wage- 
earner is in such an estimate counted on a par with an expenditure of $10 by 
a wealthy invalid for a dainty morsel of food, although the loss in " utility " 
to the former is vastly greater than that to the latter. 

& Among those who have included health in the category of wealth are 
Davenant, Petty, Canard, Say, McCullough, Roscher, Wittstein, Walras, Engel, 
Weiss, Dargun, Ofner, Nicholson, and Pareto. See Irving Fisher: "The Nature 
of Capital and Income." New York (Macmillan), 1906, p. 5. 



fisher.] NATIONAL VITALITY. 747 

Without enlarging or insisting upon this concept, it is obvious that 
by the conservation of health we may ultimately save billions of 
dollars of wasted values, and that this conservation is intimately 
related to conservation of all other kinds. a 

We have already seen the vicious circle set up between poverty and 
disease, each of which tends to produce the other. Metchnikoff 6 con- 
tends that health and morality are correlative, if not interchangeable, 
terms. A similar idea has been elaborated statistically by Dr. George 
M. Gould. The subject is worth much further study. National 
efficiency is crippled by any one or all of the parts of the vicious 
circle — disease, poverty, vice, vagabondage, crime. It would be 
interesting to study the tramp problem, which represents an enor- 
mous waste of labor power, in relation to all these phenomena. 

Section 2. — Conservation of natural resources. 

It is also true that health begets wealth, and vice versa. Whatever 
diminishes poverty or increases the physical means of welfare has the 
improvement of health as one of its first and most evident effects. 
Therefore an important method of maintaining vital efficiency is to 
conserve our natural resources — our land, our raw materials, our for- 
ests, and our water. Only in this way can we obtain food, clothing, 
shelter, and the other means of maintaining life. Conversely, the 
conservation of health will tend in several ways to the conservation 
of wealth. First of all, the more vigorous and long-lived the race, 
the better utilization can it make of its natural resources. The labor 
power of such a race is greater, more intense, more intelligent, and 
more inventive. 

The development of our natural resources in the future will be 
more dependent on technical invention d than upon the mere abun- 
dance of materials. 

Just as in warfare it is not so much the gun as the man behind 
the gun that makes for success, so in industry, as Doctor Shadwell e 
has shown, skill, knowledge, and inventiveness are the chief factors 
in determining commercial success and supremacy. The backward 
nations, like China, are characterized by lack of modern inventions. 
The nations which are industrially most advanced have the railway, 
the steamship, the power loom, metal working, and innumerable arts 
and crafts. The change of Japan from a backward to a forward 
nation is at bottom the introduction of inventions. If conservation 
prevents lessened fertility, invention makes two blades of grass grow 
where one grew before. 

Future industrial competition will be increasingly a contest of in- 
vention. The world rivalry to develop the best system of wireless 
telegraphy or the best airships is but one example. The future will 
see the greatest strides taken by the nation which is the most invent - 

° See Edward Devine, "Efficiency and Relief," New York (Macniillan), 1906. 

ft Prolongation of Life, p. 318. 

c " Disease and sin," American Medical Journal, Aug. 31 and Sept. 7, 1901. 

d Since the above was written, President Charles S. Howe, of Cleveland, has 
presented this point in detail. See " The function of the engineer in the con- 
servation of the natural resources of the country," Science, Oct. 23, 1908. 

e Arthur Shadwell in his admirable "Industrial Efficiency" (2 vols.). Lon- 
don (Longmans), 1906. 

S. Doc. 419, 61-2 9 



748 REPOET OF NATIONAL CONSERVATION COMMISSION. 

ive. Now, the primary condition of invention is vitality, a clear 
brain in a normal body. It is no accident that Edison is a health 
culturist, or that Krupp, Westinghouse, and other pioneers in indus- 
trial development have been men of vigor of mind and body. 

Finally, the conservation of health will promote the conservation 
of other resources by keeping and strengthening the faculty of fore- 
sight. One cause of poverty in the individual and the nation is lack 
of forethought. 

One of the first symptoms of racial degeneracy is decay of fore- 
sight. Normal, healthy men care for and provide for their descend- 
ants. A normal, healthy race of men, and such alone, will enact 
the laws or develop the public sentiment needed to conserve natural 
resources for generations yet unborn. When in Rome foresight 
was lost, care for future generations practically ceased. Physical 
degeneracy brought with it moral and intellectual degeneracy. In- 
stead of conserving their resources the spendthrift Romans, from the 
emperor down, began to feed on their colonies and to eat up their 
capital. Instead of building new structures they used their old 
coliseum as a quarry and a metal mine. 6 

The problem of the conservation of our natural resources is there- 
fore not a series of independent problems, but a coherent all-embra- 
cing whole. If our nation cares to make any provision for its grand- 
children and its grandchildren's grandchildren, this provision must 
include conservation in all its branches — but above all, the conserva- 
tion of the racial stock itself. 

Chapter XIV. — Things which need to be done. 
Section 1. — Enumeration of principal measures. 

In order that American vitality may reach its maximum devel- 
opment, many things need to be done. Among them are the fol- 
lowing : 

1. The National Government, the States, and the municipalities 
should steadfastly devote their energies and resources to the protec- 
tion of the people from disease. Such protection is quite as properly 
a governmental function as is protection from foreign invasion, from 
criminals, or from fire. It is both bad policy and bad economy 
to leave this work mainly to the weak and spasmodic efforts of 
charity, or to the philanthropy of physicians. 

2. The National Government should exercise at least three public 
health functions: First, investigation; second, the dissemination of 
information; third, administration. 

It should remove the reproach that more pains are now taken to 
protect the health of farm cattle than of human beings. It should 
provide more and greater laboratories for research in preventive 
medicine and public hygiene. Provision should also be made for 
better and more universal vital statistics, without which it is impos- 
sible to know the exact conditions in an epidemic, or, in general, 
the sanitary or insanitary conditions in any part of the country. 

°See Irving Fisher: "The Rate of Interest," New York (Macmillan), 1907. 
6 See John Rae : " Sociological Theory of Capital," edited by Prof. O. W. 
Mixter, New York (Macmillan), 1905. 



fisher.] NATIONAL. VITALITY. 749 

It should aim, as should state and municipal legislation, to procure 
adequate registration of births, statistics of which are at present 
lacking throughout the United States. 

The National Government should prevent transportation of dis- 
ease from State to State in the same way as it now provides for 
foreign quarantine and the protection of the nation from the impor- 
tation of disease by foreign immigrants. It should provide for the 
protection of the passenger in interstate railway travel from infection 
by his fellow-passengers and from insanitary conditions in sleeping 
cars, etc. 

It should enact suitable legislation providing against pollution of 
interstate streams. 

It should provide for the dissemination of information in regard 
to the prevention of tuberculosis and other diseases, the dangers of 
impure air, impure foods, impure milk, imperfect sanitation, ventila- 
tion, etc. Just as now the Department of Agriculture supplies 
specific information to the farmer in respect to raising crops or live 
stock, so should one of the departments, devoted principally to health 
and education, be able to provide every health officer, school-teacher, 
employer, physician, and private family with specific information in 
regard to public, domestic, and personal hygiene. 

It should provide for making the national capital into a model 
sanitary city, free from insanitary tenements and workshops, air 
pollution, water pollution, food pollution, etc., with a rate of death 
and a rate of illness among infants and among the population gen- 
erally so low and so free from epidemics of typhoid or other diseases 
as will arouse the attention of the entire country and the world. 

There should be a constant adaptation of the pure-food laws to 
changing conditions. Meat inspection and other inspection should be 
so arranged as to protect not only foreigners, but our own citizens. 
The existing health agencies of the Government should be concen- 
trated in one department, better coordinated, and given more powers 
and appropriations. 

3. State boards of health and state legislation should provide for 
the regulation of labor of women, should make plrysiological condi- 
tions for women's work and prevent their employment before and 
after childbirth; should regulate the age at which children shall be 
employed, make reasonable regulations in regard to hours of labor 
and against the dangers in hazardous trades, and especially against 
the particular dangers of dust and poisonous chemicals ; should make 
regulations for sanitation and provide inspection of factories, schools, 
asylums, prisons, and other public institutions. Where municipalities 
have not the powers to enact the legislation above mentioned with 
reference to local conditions, the necessary legislation or authority 
should be provided by the State. Or where by reason of the small 
size of the town no efficient local action is possible, the State should 
exercise the necessary functions. It should in such cases advise and 
supervise local boards of health. It should have an engineering de- 
partment and advise regarding the construction of sewers and water 
supplies. Pollution of such supplies, unless entirely local, should be 
prevented by the State, which should be equipped with laboratories 
for the analysis of water, milk, and other foods. Suitable legislation 
should be passed regulating the sale of drugs, especially preparations 



750 REPORT OF NATIONAL CONSERVATION COMMISSION. 

containing cocaine, opium, or alcohol. Legislation — not too far in 
advance of public sentiment needed to enforce it — should be passed 
regulating the sale of alcoholic beverages. State registration of 
births, deaths, and cases of illness should be much more general and 
efficient than at present. 

4. Municipal boards of health need to have more powers and 
greater appropriations; less political interference and better trained 
health officers ; more support in public opinion. Their ordinances in 
regard to expectoration, notification of infectious disease, etc., should 
be better enforced by the police departments. 

More legislation should be advocated, passed, and enforced to 
the end that streets may be kept clean, garbage properly removed, 
sewage properly disposed of, air pollution of all kinds prevented, 
whether by smoke, street dust, noxious gases, or any other source. 
Noises also should be lessened. 

Municipalities need also to take measures to prevent infection being 
carried by flies, mosquitoes, other insects and vermin, and by prosti- 
tution. They need to guard with greater care the water supply, and 
in many cases to filter it; they should make standards for milk pu- 
rity and enforce them ; they should also regularly inspect other foods 
exposed for sale; provide for sanitary inspection of local slaughter- 
houses, dairies, shops, lodging and boarding houses, and other estab- 
lishments within the power of the particular municipality; they 
should make and enforce stricter building laws, especially as relating 
to tenements, to the end that dark-room tenements may be eliminated 
and all tenements be provided with certain minimum standard re- 
quirements as to light, air, and sanitary arrangements. 

5. School children should be medically inspected and school 
hygiene universally practiced. This involves better protection 
against school epidemics, better ventilation, light, and cleanliness of 
the schoolroom, the discovery and correction of adenoids, eye strain, 
and nervous strain generally, and the provision for playgrounds. 
Sound scientific hygiene should be taught in all schools, public, pri- 
vate, normal, and technical, as also in colleges and universities. 

6. The curricula of medical schools should be rearranged with a 
greater emphasis on prevention and on the training of health officers. 
Sanatoria and hospitals, dispensaries, district nursing, tuberculosis 
classes, and other semipublic institutions should be increased in num- 
ber and improved in quality. The medical profession, keeping pace 
with these changes, should be the chief means of conveying their 
benefits to the public. Universities and research institutions need 
to take up the study of hygiene in all its branches. Now that the 
diseases of childhood are receiving attention, the next step should 
be to study the diseases of middle life. These are diseases, to a large 
extent, of nutrition and circulation, and consequently these subjects 
should receive special attention. Intelligent action must rest on 
knowledge, and knowledge of preventing disease is as yet extremely 
imperfect. 

7. In industrial and commercial establishments employers may 
greatly aid the health movement, and in many cases make their phi- 
lanthropy self-supporting by providing social secretaries, lunch and 
rest rooms, physiological (generally shorter) hours of work, pro- 
vision for innocent amusements, seats for women, etc. 



fisher.] NATIONAL VITALITY. 751 

Life insurance companies could properly and with much profit 
club together to instruct their risks in self -care and secure general 
legislation and enforcement of legislation in behalf of public health. 

8. The present striking change in personal habits of living should 
be carried out to its logical conclusion until the health ideals and the 
ideals of athletic training shall become universal. This change in- 
volves a quiet revolution in habits of living, a more intelligent utili- 
zation of one's environment, especially in regard to the condition of 
the air in our houses, the character of the clothes we wear, of the 
site and architecture of the dwelling with respect to sunlight, soil, 
ventilation, and sanitation, the character of food, its cooking, the 
use of alcohol, tobacco, and drugs, and last, but not least, sex hygiene 
in all its bearings. 

9. The fight against disease will aid in the fight against pauper- 
ism and crime. It is also true that any measures which tend to elimi- 
nate poverty, vice, and crime will tend to improve sanitary condi- 
tions. 

10. Finally, eugenics, or hygiene for future generations, should be 
studied and gradually put in practice. This involves the prohibi- 
tion of flagrant cases of marriages of the unfit, such as syphilitics, 
the insane, feeble-minded, epileptics, paupers, or criminals, etc. The 
example of Indiana in this regard should be considered and followed 
by other States, as also in regard to the unsexing of rapists, criminals, 
idiots, and degenerates generally. A public opinion should be 
aroused which will not only encourage healthy and discountenance 
degenerate marriages, but will become so embedded in the minds of 
the rising generation as will unconsciously, but powerfully, affect 
their marriage choices. 



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